Diagnosis and management of drug hypersensitivity reactions

Antonino Romano, Maria J. Torres, Mariana Castells, Maria L. Sanz, Miguel Blanca

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

The present article addresses the advances in the diagnosis and management of drug hypersensitivity reactions that were discussed in the 4th Drug Hypersensitivity Meeting held in Rome in April 2010. Such reactions can be classified as immediate or nonimmediate according to the time interval between the last drug administration and onset. Immediate reactions occur within 1 hour, and nonimmediate reactions occur after more than 1 hour. Clinical and immunologic studies suggest that type-I (IgE-mediated) and type-IV (T cell-mediated) pathogenic mechanisms are involved in most immediate and nonimmediate reactions, respectively. In diagnosis prick, patch, and intradermal tests are the most readily available tools. Determination of specific IgE levels is still the most common in vitro method for diagnosing immediate reactions. New diagnostic tools, such as the basophil activation test, the lymphocyte activation test, and enzyme-linked immunospot assays for analysis of the frequency of antigen-specific, cytokine-producing cells, have been developed for evaluating either immediate or nonimmediate reactions. The sensitivity of allergologic tests is not 100%; therefore in selected cases provocation tests are necessary. In the diagnosis of nonallergic hypersensitivity reactions to nonsteroidal anti-inflammatory drugs, the provocation test with the suspected drug still represents the "gold standard." However, there was no consensus regarding the use of this test in subjects with histories of hypersensitivity reactions to 1 (single reactors) or more (multiple reactors) nonsteroidal anti-inflammatory drugs. With regard to management, desensitization allows patients to be treated with irreplaceable chemotherapy agents, such as taxanes, platinum salts, and mAbs, to which they have presented hypersensitivity reactions. Desensitization also permits the use of aspirin in aspirin-sensitive patients undergoing revascularization and in subjects with aspirin-exacerbated respiratory disease.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Volume127
Issue number3 SUPPL.
DOIs
Publication statusPublished - Mar 2011

Fingerprint

Drug Hypersensitivity
Aspirin
Hypersensitivity
Pharmaceutical Preparations
Immunoglobulin E
Anti-Inflammatory Agents
Intradermal Tests
Enzyme-Linked Immunospot Assay
Taxoids
Patch Tests
Basophils
Lymphocyte Activation
Platinum
Salts
Cytokines
T-Lymphocytes
Antigens
Drug Therapy

Keywords

  • β-lactams
  • Anticonvulsants
  • desensitization
  • diagnosis
  • drugs
  • hypersensitivity
  • nonsteroidal anti-inflammatory drugs

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Diagnosis and management of drug hypersensitivity reactions. / Romano, Antonino; Torres, Maria J.; Castells, Mariana; Sanz, Maria L.; Blanca, Miguel.

In: Journal of Allergy and Clinical Immunology, Vol. 127, No. 3 SUPPL., 03.2011.

Research output: Contribution to journalArticle

Romano, Antonino ; Torres, Maria J. ; Castells, Mariana ; Sanz, Maria L. ; Blanca, Miguel. / Diagnosis and management of drug hypersensitivity reactions. In: Journal of Allergy and Clinical Immunology. 2011 ; Vol. 127, No. 3 SUPPL.
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