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dc.contributor.authorLehloenya, Rannakoe J-
dc.contributor.authorPeter, Jonny G-
dc.contributor.authorCopaescu, Ana-
dc.contributor.authorTrubiano, Jason A-
dc.contributor.authorPhillips, Elizabeth J-
dc.identifier.citationThe Journal of Allergy and Clinical Immunology. In Practice 2020; 8(9): 2878-2895.e6en
dc.description.abstractDelayed 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.en
dc.subjectDelayed hypersensitivityen
dc.subjectDrug challengeen
dc.subjectDrug timelineen
dc.subjectEx vivoen
dc.subjectIn vivoen
dc.subjectLymphocyte transformationen
dc.titleDelabeling Delayed Drug Hypersensitivity: How Far Can You Safely Go?en
dc.typeJournal Articleen
dc.identifier.journaltitleThe Journal of Allergy and Clinical Immunology. In Practiceen
dc.identifier.affiliationDivision of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africaen
dc.identifier.affiliationThe National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDivision of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africaen
dc.identifier.affiliationMedicine (University of Melbourne)en
dc.identifier.affiliationCentre for Antibiotic Allergy and Researchen
dc.identifier.affiliationCenter 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, Australiaen
dc.identifier.affiliationInfectious Diseasesen
item.openairetypeJournal Article-
item.fulltextNo Fulltext- Diseases- Diseases- (University of Melbourne)- for Antibiotic Allergy and Research-
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