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Drug Hypersensitivity: Clinical Manifestations and Diagnosis

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Allergy Frontiers: Clinical Manifestations

Part of the book series: Allergy Frontiers ((ALLERGY,volume 3))

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Abstract

Drug hypersensitivity, including the allergic type, is one of the side effects of drugs and is a daily worry for the clinician. Even though urticarial and maculopapular eruptions are the most frequent manifestations, there are many clinical forms, mirroring many distinct pathophysiological events. The diagnosis of drug hypersensitivity often relies on clinical histories, skin tests, patch tests, and a few validated in vitro tests, such as serum specific IgE assays, which are available only for a few drugs. The sensitivity of these tests is not 100%; in selected cases, therefore, provocation tests are necessary. However, new diagnostic tools, such as the basophil activation test and the lymphocyte activation test, have been developed and are under validation. Their routine use could increase the sensitivity of diagnostic work-ups, thus reducing the need for drug provocation tests.

Most of these diagnostic tools have been carefully evaluated by the European Network of Drug Allergy (the European Academy of Allergology and Clinical Immunology drug hypersensitivity interest group). When properly performed in specialised centres, a firm diagnosis is often possible and safe alternative medication can be proposed.

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References

  1. Johansson S, Bieber T, Dahl R, et al. (2004) Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 113:832–836

    Article  PubMed  CAS  Google Scholar 

  2. Gomes ER, Demoly P (2005) Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol 5:309–316

    PubMed  Google Scholar 

  3. Gomes E, Cardoso MF, Praça F, et al. (2004) Self reported drug allergy in a general adult Portuguese population. Clin Exp Allergy 34:1597–1601

    Article  PubMed  CAS  Google Scholar 

  4. Backstrom M, Mjorndal, Dahlqvist R (2004) Under-reporting of serious adverse drug reactions in Sweden. Pharmacoepidemiol Drug Saf 13:483–487

    Article  PubMed  CAS  Google Scholar 

  5. Mittmann N, Knowles SR, Gomez M, et al. (2004) Evaluation of the extent of underreporting of serious adverse drug reactions: the case of toxic epidermal necrolysis. Drug Saf 27:477–487

    Article  PubMed  Google Scholar 

  6. Messaad D, Sahla H, Benahmed S, et al. (2004) Drug provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann Intern Med 140:1001–1006

    PubMed  Google Scholar 

  7. Pichler WJ (2003) Delayed drug hypersensitivity reactions. Ann Intern Med 139:683–693

    PubMed  CAS  Google Scholar 

  8. Demoly P, Kropf R, Bircher A, Pichler WJ (1999) Drug hypersensitivity questionnaire. Allergy 54:999–1003

    Article  PubMed  CAS  Google Scholar 

  9. Bircher AJ (2005) Symptoms and danger signs in acute drug hypersensitivity. Toxicology 209:201–207

    Article  PubMed  CAS  Google Scholar 

  10. Brockow K, Romano A, Blanca M, et al. (2002) General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy 57:45–51

    Article  PubMed  CAS  Google Scholar 

  11. Barbaud A, Reichert-Penetrat S, Trechot P, et al. (1998) The use of skin testing in the investigation of cutaneous adverse drug reactions. Br J Dermatol 139:49–58

    Article  PubMed  CAS  Google Scholar 

  12. Romano A, Blanca M, Torres MJ, et al. (2004) Diagnosis of nonimmediate reactions to beta-lactam antibiotics. Allergy 59:1153–1160

    Article  PubMed  CAS  Google Scholar 

  13. Blanca M, Romano A, Torres MJ, et al. (2007) Continued need of appropriate betalactam-derived skin test reagents for the management of allergy to betalactams. Clin Exp Allergy 37:166–173

    Article  PubMed  CAS  Google Scholar 

  14. Torres MJ, Blanca M, Fernandez J, et al. (2003) Diagnosis of immediate allergic reactions to beta-lactam antibiotics. Allergy 58:961–972

    Article  PubMed  CAS  Google Scholar 

  15. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology (1999) Executive summary of disease management of drug hypersensitivity: a practice parameter. Ann Allergy Asthma Immunol 83:665–700

    Google Scholar 

  16. Rodríguez-Bada JL, Montañez MI, Torres MJ, et al. (2006) Skin testing for immediate hyper-sensitivity to betalactams: comparison between two commercial kits. Allergy 61:947–951

    Article  PubMed  CAS  Google Scholar 

  17. Romano A, Viola M, Bousquet JP, et al. (2007) A comparison of the performance of two penicillin reagent kits in the diagnosis of β-lactam hypersensitivity. Allergy 62:53–58

    Article  PubMed  CAS  Google Scholar 

  18. Romano A, Guéant-Rodriguez RM, Viola M, et al. (2005) Diagnosing immediate reactions to cephalosporins. Clin Exp Allergy 35:1234–1242

    Article  PubMed  CAS  Google Scholar 

  19. Antunez C, Blanca-Lopez N, Torres MJ, et al. (2006) Immediate allergic reactions to cepha-losporins: evaluation of cross-reactivity with a panel of penicillins and cephalosporins. J Allergy Clin Immunol 117:404–410

    Article  PubMed  CAS  Google Scholar 

  20. Guéant JL, Guéant-Rodriguez RM, Viola, M et al. (2006) IgE-mediated hypersensitivity to cephalosporins. Curr Pharm Des 12:3335–3345

    Article  PubMed  Google Scholar 

  21. Romano A, Guéant-Rodriguez RM, Viola M, et al. (2004) Cross-reactivity and tolerability of cephalosporins in patients with immediate hypersensitivity to penicillins. Ann Intern Med 141:16–22

    PubMed  CAS  Google Scholar 

  22. Romano A, Viola M, Guéant-Rodriguez RM, et al. (2006) Imipenem in patients with immediate hypersensitivity to penicillins [Letter]. N Engl J Med 354:2835–2837

    Article  PubMed  CAS  Google Scholar 

  23. Romano A, Viola M, Guéant-Rodriguez RM, et al. (2007) Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins. Ann Intern Med 146:266–269

    PubMed  Google Scholar 

  24. Mertes PM, Laxenaire MC, Lienhart A, et al. (2005) Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Invest Allergy Clin Immunol 15:91–101

    CAS  Google Scholar 

  25. Brockow K, Christiansen C, Kanny G, et al. (2005) Management of hypersensitivity reactions to iodinated contrast media. Allergy 60:150–158

    Article  PubMed  CAS  Google Scholar 

  26. Guéant-Rodríguez RM, Romano A, Barbaud A, et al. (2006) Hypersensitivity reactions to iodinated contrast media. Curr Pharm Des 12:3359–3372

    Article  PubMed  Google Scholar 

  27. Kanny G, Pichler W, Morisset M, et al. (2005) T cell–mediated reactions to iodinated contrast media: evaluation by skin and lymphocyte activation tests. J Allergy Clin Immunol 115:179–185

    Article  PubMed  CAS  Google Scholar 

  28. Kvedariene V, Martins P, Ruanet L, Demoly P (2006) Diagnosis of iodinated contrast media hypersensitivity: results of a 6-year period. Clin Exp Allergy 36:1072–1077

    Article  PubMed  CAS  Google Scholar 

  29. Bircher AJ, Harr T, Hohenstein L, Tsakiris DA (2006) Hypersensitivity reactions to anticoagulant drugs: diagnosis and management options. Allergy 61:1432–1440

    Article  PubMed  CAS  Google Scholar 

  30. Leguy-Seguin V, Jolimoy G, Coudert B, et al. (2007) Diagnostic and predictive value of skin testing in platinum salt hypersensitivity. J Allergy Clin Immunol 119:726–730

    Article  PubMed  CAS  Google Scholar 

  31. Popescu NA, Sheehan MG, Kouides PA, et al. (1996) Allergic reactions to cyclophosphamide: delayed clinical expression associated with positive immediate skin tests to drug metabolites in five patients. J Allergy Clin Immunol 97:26–33

    Article  PubMed  CAS  Google Scholar 

  32. Lee AY, Chey WY (2003) Patch testing with carbamazepine and its main metabolite carbamazepine epoxide in cutaneous adverse drug reactions to carbamazepine. Contact Dermatitis 48:137–139

    Article  PubMed  CAS  Google Scholar 

  33. Aberer W, Bircher A, Romano A, et al. (2003) Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 58:854–863

    Article  PubMed  CAS  Google Scholar 

  34. Wong BB, Keith PK, Waserman S (2006) Clinical history as a predictor of penicillin skin test outcome. Ann Allergy Asthma Immunol 97:169–174

    Article  PubMed  Google Scholar 

  35. Wöhrl S, Vigl K, Stingl G (2006) Patients with drug reactions – it is worth testing? Allergy 61:828–934

    Article  CAS  Google Scholar 

  36. Fontaine C, Mayorga L, Bousquet PJ, et al. (2007) Relevance of the determination of serum-specific IgE antibodies in the diagnosis of immediate beta-lactam allergy. Allergy 62:47–52

    Article  PubMed  CAS  Google Scholar 

  37. Guéant JL, Mata E, Monin B, et al. (1991) Evaluation of a new reactive solid phase for radio-immunoassay of serum specific IgE against muscle relaxant drugs. Allergy 46:452–458

    PubMed  Google Scholar 

  38. Manfredi M, Severino M, Testi S, et al. (2004) Detection of specific IgE to quinolones. J Allergy Clin Immunol 113:155–160

    Article  PubMed  CAS  Google Scholar 

  39. Demoly P, Lebel B, Messaad D, et al. (1999) Predictive capacity of histamine release for the diagnosis of drug allergy. Allergy 54:500–506

    Article  PubMed  CAS  Google Scholar 

  40. Lebel B, Messaad D, Kvedariene V, et al. (2001) Cysteinyl-leukotriene release test (CAST) in the diagnosis of immediate drug reactions. Allergy 56:688–692

    Article  PubMed  CAS  Google Scholar 

  41. Watkins J, Wild G (1993) Improved diagnosis of anaphylactoid reactions by measurement of serum tryptase and urinary methylhistamine. Ann Fr Anesth Reanim 12:169–172

    PubMed  CAS  Google Scholar 

  42. Ebo DG, Sainte-Laudy J, Bridts CH, et al. (2006) Flow-assisted allergy diagnosis: current applications and future perspectives. Allergy 61:1028–1039

    Article  PubMed  CAS  Google Scholar 

  43. Kvedariene V, Kamey S, Ryckwaert Y, et al. (2006) Diagnosis of neuromuscular blocking agent hypersensitivity reactions using cytofluorimetric analysis of basophils. Allergy 61:311–315

    Article  PubMed  CAS  Google Scholar 

  44. Sanz ML, Gamboa PM, Antépara I, et al. (2002) Flow cytometric basophil activation test by detection of CD63 expression in patients with immediate-type reactions to betalactam antibiotics. Clin Exp Allergy 32:277–286

    Article  PubMed  CAS  Google Scholar 

  45. Torres MJ, Padial A, Mayorga C, et al. (2004) The diagnostic interpretation of basophil activation test in immediate allergic reactions to betalactams. Clin Exp Allergy 34:1768–1775

    Article  PubMed  CAS  Google Scholar 

  46. Sanz ML, Gamboa P, de Weck AL (2005) A new combined test with flowcytometric basophil activation and determination of sulfidoleukotrienes is useful for in vitro diagnosis of hyper-sensitivity to aspirin and other nonsteroidal anti-inflammatory drugs. Int Arch Allergy Immunol 136:58–72

    Article  PubMed  CAS  Google Scholar 

  47. Nyfeler B, Pichler WJ (1997) The lymphocyte transformation test for the diagnosis of drug allergy: sensitivity and specificity. Clin Exp Allergy 27:175–181

    Article  PubMed  CAS  Google Scholar 

  48. Pichler WJ, Tilch J (2004) The lymphocyte transformation test in the diagnosis of drug hyper-sensitivity. Allergy 59:809–820

    Article  PubMed  CAS  Google Scholar 

  49. Schmid DA, Depta JP, Pichler WJ (2006) T cell-mediated hypersensitivity to quinolones. Clin Exp Allergy 36:59–69

    Article  PubMed  CAS  Google Scholar 

  50. Demoly P, Messaad D, Sahla H, et al. (1998) Six-hour trimethoprim-sulfamethoxazole graded challenge in HIV-infected patients. J Allergy Clin Immunol 102:1033–1036

    Article  PubMed  CAS  Google Scholar 

  51. Castells M (2006) Desensitization for drug allergy. Curr Opin Allergy Clin Immunol 6:476–481

    PubMed  CAS  Google Scholar 

  52. Castells M (2006) Rapid desensitization for hypersensitivity reactions to chemotherapy agents. Curr Opin Allergy Clin Immunol 6:271–277

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Professor and Head, Allergy Department, Meladies Respiratories-Hôpital Arnaud de Villeneuve, University Hospital of Montpellier-Inserm U657, Montpellier cedex, 34295, France

    Pascal Demoly

  2. Unità di Allergologia, Complesso Integrato Columbus, via G. Moscati, 31, Rome, I-00168, Italy

    Antonino Romano

  3. IRCCS Oasi Maria S.S., Troina, Italy

    Antonino Romano

Authors
  1. Pascal Demoly
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  2. Antonino Romano
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Editors and Affiliations

  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. Southampton General Hospital, University of Southampton, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. Childrens's Mercy Hospital and Clinic, UMKC School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

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© 2009 Springer

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Demoly, P., Romano, A. (2009). Drug Hypersensitivity: Clinical Manifestations and Diagnosis. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Clinical Manifestations. Allergy Frontiers, vol 3. Springer, Tokyo. https://doi.org/10.1007/978-4-431-88317-3_24

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  • DOI: https://doi.org/10.1007/978-4-431-88317-3_24

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-88316-6

  • Online ISBN: 978-4-431-88317-3

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