Controversies in drug allergy: Testing for delayed reactions

Elizabeth J Phillips, Paul Bigliardi, Andreas J Bircher, Ana Broyles, Yoon-Seok Chang, Wen-Hung Chung, Rannakoe Lehloenya, Maja Mockenhaupt, Jonny Peter, Munir Pirmohamed, Jean-Claude Roujeau, Neil H Shear, Luciana Kase Tanno, Jason Trubiano, Rocco Valluzzi, Annick Barbaud

Research output: Contribution to journalReview article

Abstract

Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.

Original languageEnglish
Pages (from-to)66-73
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Volume143
Issue number1
DOIs
Publication statusE-pub ahead of print - 2018

Fingerprint

Drug Eruptions
Drug Hypersensitivity
Stevens-Johnson Syndrome
Drug-Related Side Effects and Adverse Reactions
Acute Generalized Exanthematous Pustulosis
Drug Hypersensitivity Syndrome
Drug Tolerance
HLA-B Antigens
Carbamazepine
Pharmaceutical Preparations
Hypersensitivity
T-Lymphocytes
Phenotype
Skin
In Vitro Techniques
HLA-B57 antigen
abacavir
Direction compound

Cite this

Phillips, E. J., Bigliardi, P., Bircher, A. J., Broyles, A., Chang, Y-S., Chung, W-H., ... Barbaud, A. (2018). Controversies in drug allergy: Testing for delayed reactions. Journal of Allergy and Clinical Immunology, 143(1), 66-73. https://doi.org/10.1016/j.jaci.2018.10.030

Controversies in drug allergy : Testing for delayed reactions. / Phillips, Elizabeth J; Bigliardi, Paul; Bircher, Andreas J; Broyles, Ana; Chang, Yoon-Seok; Chung, Wen-Hung; Lehloenya, Rannakoe; Mockenhaupt, Maja; Peter, Jonny; Pirmohamed, Munir; Roujeau, Jean-Claude; Shear, Neil H; Tanno, Luciana Kase; Trubiano, Jason; Valluzzi, Rocco; Barbaud, Annick.

In: Journal of Allergy and Clinical Immunology, Vol. 143, No. 1, 2018, p. 66-73.

Research output: Contribution to journalReview article

Phillips, EJ, Bigliardi, P, Bircher, AJ, Broyles, A, Chang, Y-S, Chung, W-H, Lehloenya, R, Mockenhaupt, M, Peter, J, Pirmohamed, M, Roujeau, J-C, Shear, NH, Tanno, LK, Trubiano, J, Valluzzi, R & Barbaud, A 2018, 'Controversies in drug allergy: Testing for delayed reactions' Journal of Allergy and Clinical Immunology, vol. 143, no. 1, pp. 66-73. https://doi.org/10.1016/j.jaci.2018.10.030
Phillips EJ, Bigliardi P, Bircher AJ, Broyles A, Chang Y-S, Chung W-H et al. Controversies in drug allergy: Testing for delayed reactions. Journal of Allergy and Clinical Immunology. 2018;143(1):66-73. https://doi.org/10.1016/j.jaci.2018.10.030
Phillips, Elizabeth J ; Bigliardi, Paul ; Bircher, Andreas J ; Broyles, Ana ; Chang, Yoon-Seok ; Chung, Wen-Hung ; Lehloenya, Rannakoe ; Mockenhaupt, Maja ; Peter, Jonny ; Pirmohamed, Munir ; Roujeau, Jean-Claude ; Shear, Neil H ; Tanno, Luciana Kase ; Trubiano, Jason ; Valluzzi, Rocco ; Barbaud, Annick. / Controversies in drug allergy : Testing for delayed reactions. In: Journal of Allergy and Clinical Immunology. 2018 ; Vol. 143, No. 1. pp. 66-73.
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AU - Broyles, Ana

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AU - Chung, Wen-Hung

AU - Lehloenya, Rannakoe

AU - Mockenhaupt, Maja

AU - Peter, Jonny

AU - Pirmohamed, Munir

AU - Roujeau, Jean-Claude

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AU - Tanno, Luciana Kase

AU - Trubiano, Jason

AU - Valluzzi, Rocco

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N1 - Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

PY - 2018

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N2 - Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.

AB - Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.

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