Phenotypes and Natural Evolution of Drug Hypersensitivity
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Purpose of review
Drug hypersensitivity reactions (DHRs) are adverse effects that clinically resemble allergy. They belong to type B adverse drug reactions, which are dose-independent and unpredictable. Misclassification of DHR may lead to under and/or overdiagnosis, which affects the management of patients, leading to higher risk of suffering an allergic reaction or the use of alternative more-expensive and potentially less-effective drugs. A precise phenotype of DHR is required for a better evaluation and proper management of patients experiencing DHR. The purpose of this review is to summarise the different phenotypes of DHR basing on different criterions.
The phenotyping of DHRs is challenging as clinical presentations are heterogeneous, the underlying mechanism is poorly understood and terminology varies among different studies. Moreover, natural evolution may be different depending on the phenotype.
This review summarises the complexity of DHR phenotyping, which can be based on different criterions as chronology, mechanism and clinical symptoms as well as natural evolution. A precise phenotyping of DHR is needed to determine the adequate evaluation and management of patients.
KeywordsAnaphylaxis Exanthema Hypersensitivity Immediate Non-immediate Urticaria
I Doña holds a Juan Rodes research contract (JR15/00036) and NI Pérez-Sánchez holds a Rio Hortega contract (CM17/00141), both from the Carlos III National Health Institute, Spanish Ministry of Economy and Competitiveness (grants cofounded by European Social Fund, ESF).
Compliance with Ethical Standards
Conflict of Interest
Inmaculada Doña, María Salas, Natalia Isabel Pérez-Sánchez, Carmen Moreno-Aguilar and María José Torres declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.International drug monitoring. The role of national centres Report of a WHO meeting. World Health Organ Tech Rep Ser. 1972;498:1–25.Google Scholar
- 5.Rawlins MD, T.J., Pathogenesis of adverse drug reactions, in Textbook of adverse drug reactions, D. DM, Editor. 1977, Oxford University Press: Oxford. p. 10.Google Scholar
- 6.Bernstein JA. Nonimmunologic adverse drug reactions. How to recognize and categorize some common reactions. Postgrad Med. 1995;98(1):120–2 125-6.Google Scholar
- 7.•• Demoly P, et al. International consensus on drug allergy. Allergy. 2014;69(4):420–37 In this position paper, the International Collaboration in Asthma, Allergy and Immunology (iCAALL) critically reviewed guidelines and consensus documents on DHR and compiled an International CONsensus (ICON) providing recommendations on drug allergy.PubMedGoogle Scholar
- 8.Joint Task Force on Practice, P, et al. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259–73.Google Scholar
- 9.Bernstein JA. Allergic drug reactions. How to minimize the risks. Postgrad Med. 1995;98(2):159–60 163-6.Google Scholar
- 13.Coombs PR, G.P., Classification of allergic reactions responsible for clinical hypersensitivity and disease. . In: Gell RR, editor. Clinical aspects of immunology. Oxford (UK): Oxford University Pess;, 1968: p. 575–96.Google Scholar
- 16.•• Kowalski ML, et al. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy. 2013;68(10):1219–32 This position paper provides a classification of reactions induced by NSAIDs based on clinical manifestations and suspected mechanism.PubMedGoogle Scholar
- 21.Limsuwan T, Demoly P. Acute symptoms of drug hypersensitivity (urticaria, angioedema, anaphylaxis, anaphylactic shock). Med Clin North Am. 2010;94(4):691–710 x.Google Scholar
- 22.• Blanca-Lopez N, et al. Allergic reactions to Metamizole: immediate and delayed responses. Int Arch Allergy Immunol. 2016;169(4):223–30 In this paper, a clinical characterization of allergic reactions to metamizol is performed, describing the symptoms induced by the drug. In this paper, the authors also discuss about the time interval between the drug intake and the onset of the reaction.PubMedGoogle Scholar
- 24.Bircher AJ, Scherer Hofmeier K. Drug hypersensitivity reactions: inconsistency in the use of the classification of immediate and nonimmediate reactions. J Allergy Clin Immunol. 2012;129(1):263–4 author reply 265-6.Google Scholar
- 25.Mockenhaupt M. Severe drug-induced skin reactions: clinical pattern, diagnostics and therapy. J Dtsch Dermatol Ges. 2009;7(2):142–60 quiz 161-2.Google Scholar
- 26.Bircher AJ, Scherer K. Delayed cutaneous manifestations of drug hypersensitivity. Med Clin North Am. 2010;94(4):711–25 x.Google Scholar
- 28.•• Zalewska-Janowska A, Spiewak R, Kowalski ML. Cutaneous manifestation of drug allergy and hypersensitivity. Immunol Allergy Clin N Am. 2017;37(1):165–81 In this review, the clinical characteristic and mechanisms involved in allergic and non-allergic hypersensitivity reactions to drugs are summarized.Google Scholar
- 29.Schnyder B. Approach to the patient with drug allergy. Med Clin North Am. 2010;94(4):665–79 xv.Google Scholar
- 31.• Setkowicz M, et al. Clinical course and urinary eicosanoids in patients with aspirin-induced urticaria followed up for 4 years. J Allergy Clin Immunol. 2009;123(1):174–8 In this study, it is analyzed the natural evolution of aspirin hypersensitivity in patients with NSAIDs-induced urticaria and underlying chronic spontaneous urticaria (NECD).PubMedGoogle Scholar
- 34.Mertes PM, et al. Perioperative anaphylaxis. Med Clin North Am. 2010;94(4):761–89 xi.Google Scholar
- 40.Doña I, et al. Trends in hypersensitivity drug reactions: more drugs, more response patterns more heterogeneity. J Investig Allergol Clin Immunol. 2014;24(3):143–53 quiz 1 p following 153.Google Scholar
- 45.•• Peter JG, et al. Severe delayed cutaneous and systemic reactions to drugs: a global perspective on the science and art of current practice. J Allergy Clin Immunol Pract. 2017;5(3):547–63 In this review, the clinical features, underlying mechanisms and management of severe delayed reactions to drugs are described.PubMedPubMedCentralGoogle Scholar
- 57.Chan HL, Stern RS, Arndt KA, Langlois J, Jick SS, Jick H, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol. 1990;126(1):43–7.PubMedGoogle Scholar
- 72.Johnson DH, Cunha BA. Drug fever. Infect Dis Clin N Am. 1996;10(1):85–91.Google Scholar
- 77.•• Fernandez TD, et al. Negativization rates of IgE radioimmunoassay and basophil activation test in immediate reactions to penicillins. Allergy. 2009;64(2):242–8 In this study, it is analyzed the loss of sensitivity of radioimmunoassay and BAT in patients reporting immediate allergic reactions to penicillin.PubMedGoogle Scholar
- 78.•• Gomez E, et al. Immunoglobulin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients. Clin Exp Allergy. 2009;39(8):1217–24 In this study, it is analyzed the negativization rate of BAT in patients reporting immediate allergic reactions to dipyrone.PubMedGoogle Scholar
- 81.•• Kvedariene V, et al. Diagnosis of neuromuscular blocking agent hypersensitivity reactions using cytofluorimetric analysis of basophils. Allergy. 2006;61(3):311–5 In this study, it is analyzed the role of BAT in the diagnosis of immediate allergic reactions to NMBA, including the negativization rate over time.PubMedGoogle Scholar