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Title: Delabeling Delayed Drug Hypersensitivity: How Far Can You Safely Go?
Austin Authors: Lehloenya, Rannakoe J;Peter, Jonny G;Copaescu, Ana ;Trubiano, Jason A ;Phillips, Elizabeth J
Affiliation: Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
Medicine (University of Melbourne)
Centre for Antibiotic Allergy and Research
Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Centre, Nashville, Tenn; Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tenn; Centre for Clinical Pharmacology and Infectious Diseases, Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
Infectious Diseases
Issue Date: Oct-2020 2020-10
Publication information: The Journal of Allergy and Clinical Immunology. In Practice 2020; 8(9): 2878-2895.e6
Abstract: Delayed immune-mediated adverse drug reactions (IM-ADRs) are defined as reactions occurring more than 6 hours after dosing. They include heterogeneous clinical phenotypes that are typically T-cell-mediated reactions with distinct mechanisms across a wide spectrum of severity from benign exanthems through to life-threatening cutaneous or organ-specific diseases. For mild reactions such as benign exanthem, considerations for delabeling are similar to immediate reactions and may include a graded or single-dose drug challenge with or without preceding skin or patch testing. Evaluation of challenging cases such as the patient who is on multiple drugs at the time a severe delayed IM-ADR occurs should prioritize clinical ascertainment of the most likely phenotype and implicated drug(s). Although not widely available and validated, procedures such as patch testing, delayed intradermal skin testing, and laboratory-based functional drug assays or genetic (human leukocyte antigen) testing may provide valuable information to further help risk stratify patients and identify the likely implicated and/or cross-reactive drug(s). The decision to use a drug challenge as a diagnostic or delabeling tool in a patient with a severe delayed IM-ADR should weigh the risk-benefit ratio, balancing the severity and priority for the treatment of the underlying, and the availability of alternative efficacious and safe treatments.
DOI: 10.1016/j.jaip.2020.07.005
Journal: The Journal of Allergy and Clinical Immunology. In Practice
PubMed URL: 33039012
Type: Journal Article
Subjects: Delabel
Delayed hypersensitivity
Drug challenge
Drug timeline
Ex vivo
In vivo
Lymphocyte transformation
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