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Title: Controversies in drug allergy: Testing for delayed reactions.
Austin Authors: 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 A ;Valluzzi, Rocco;Barbaud, Annick
Affiliation: Institute for Immunology and Infectious Diseases, Murdoch, Australia
Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
Vanderbilt University Medical Center, Nashville, Tenn
Department of Dermatology, Dermato-Allergy Division, University of Minnesota, Minneapolis, Minn, USA
Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
Department of Dermatology, Dokumentationszentrum schwerer Hautreaktionen (dZh), Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
National Centre for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia
Department of Dermatology, Allergy Unit, University Hospital, University of Basel, Basel, Switzerland
Boston Children's Hospital and Harvard Medical School, Boston, Mass, USA
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan
Division of Dermatology and Combined Drug Allergy Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa
Université Paris-Est Créteil, Créteil, France
Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
University Hospital of Montpellier, Montpellier, and Sorbonne Université, INSERM, Paris, France; Hospital Sírio Libanês, São Paulo, Brazil
Allergy Department, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
Dermatology and Allergy Department, Tenon Hospital, Medecine Sorbonne University, Paris, France
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Assistance publique-hopitaux de Paris, Paris, France
Issue Date: 2019 2018-11-30
Publication information: The Journal of allergy and clinical immunology 2019; 143(1): 66-73
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.
DOI: 10.1016/j.jaci.2018.10.030
ORCID: 0000-0002-5111-6367
PubMed URL: 30573342
Type: Journal Article
Subjects: Delayed
Stevens-Johnson syndrome/toxic epidermal necrolysis
acute generalized exanthematous pustulosis
drug reaction with eosinophilia and systemic symptoms
fixed drug eruption
oral challenge
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