Please use this identifier to cite or link to this item:
Title: Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity
Austin Authors: Konvinse, Katherine C;Phillips, Elizabeth J;White, Katie D;Trubiano, Jason 
Affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
Issue Date: Dec-2016
Publication information: Current Opinion in Infectious Diseases 2016; 29(6): 561-576
Abstract: PURPOSE OF REVIEW: Antimicrobials are a leading cause of severe T cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in-vitro, in-vivo, and ex-vivo diagnostics for T cell-mediated ADRs. RECENT FINDINGS: Recent literature has evaluated the efficacy of traditional antibiotic allergy management, including patch testing, skin prick testing, intradermal testing, and oral challenge. Although patch and intradermal testing are specific for the diagnosis of immune-mediated ADRs, they suffer from drug-specific limitations in sensitivity. The use of ex-vivo diagnostics, especially enzyme-linked immunospot, has been highlighted as a promising new approach to assigning causality. Knowledge of true rates of antimicrobial cross-reactivity aids empirical antibiotic choice in the setting of previous immune-mediated ADRs. SUMMARY: In an era of increasing antimicrobial resistance and use of broad-spectrum antimicrobial therapy, ensuring patients are assigned the correct 'allergy label' is essential. Re-exposure to implicated antimicrobials, especially in the setting of severe adverse cutaneous reaction, is associated with significant morbidity and mortality. The process through which an antibiotic label gets assigned, acted on and maintained is still imprecise. Predicting T cell-mediated ADRs via personalized approaches, including human leukocyte antigen-typing, may pave future pathways to safer antimicrobial prescribing guidelines.
DOI: 10.1097/QCO.0000000000000323
Journal: Current Opinion in Infectious Diseases
PubMed URL:
Type: Journal Article
Subjects: Anti-Bacterial Agents
Drug Hypersensitivity
Hypersensitivity, Delayed
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on May 30, 2024

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.