Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America

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Torres M. J., Romano A., ÇELİK G. E., Demoly P., Khan D. A., Macy E., ...More

CLINICAL AND TRANSLATIONAL ALLERGY, vol.7, 2017 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 7
  • Publication Date: 2017
  • Doi Number: 10.1186/s13601-017-0144-0
  • Journal Name: CLINICAL AND TRANSLATIONAL ALLERGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Keywords: Drug, Hypersensitivity, Allergy, Diagnosis, Skin test, In vitro test, IgE, T-cells, Drug provocation test, Sensitization, United States, Europe, STEVENS-JOHNSON-SYNDROME, IMMEDIATE ALLERGIC REACTIONS, BASOPHIL ACTIVATION TEST, NONSTEROIDAL ANTIINFLAMMATORY DRUGS, BETA-LACTAM ANTIBIOTICS, LYMPHOCYTE-TRANSFORMATION TEST, NEUROMUSCULAR BLOCKING-AGENTS, CETUXIMAB-INDUCED ANAPHYLAXIS, TOXIC EPIDERMAL NECROLYSIS, PARAMETER-UPDATE 2015
  • Ankara University Affiliated: Yes

Abstract

Drug hypersensitivity reactions (DHRs) affect an unknown proportion of the general population, and are an important public health problem due to their potential to cause life-threatening anaphylaxis and rare severe cutaneous allergic reactions. DHR evaluations are frequently needed in both ambulatory and hospital settings and have a complex diagnosis that requires a detailed clinical history and other tests that may include in vitro tests and in vivo procedures such as skin tests and drug provocation tests. Although over the years both European and U.S. experts have published statements on general procedures for evaluating DHRs, a substantial discordance in their daily management exists. In this review, we highlight both the differences and the similarities between the European and U.S. perspectives. While a general consensus exists on the importance of skin tests for evaluating DHRs, concordance between Americans and Europeans exists solely regarding their use in immediate reactions and the fact that a confirmation of a presumptive diagnosis by drug provocation tests is often the only reliable way to establish a diagnosis. Finally, great heterogeneity exists in the application of in vitro tests, which require further study to be well validated.