-
Allergy and Asthma Proceedings Nov 2019Drug allergy describes clinical adverse reactions that are proved or presumed to be immunologically based. Allergic drug reactions do not resemble pharmacologic actions... (Review)
Review
Drug allergy describes clinical adverse reactions that are proved or presumed to be immunologically based. Allergic drug reactions do not resemble pharmacologic actions of the incriminated drug and may occur at fractions of what would be the therapeutic dosage. Allergic drug reactions are unpredictable; nevertheless, there is increased risk of drug hypersensitivity in (1) patients with cystic fibrosis who receive antibiotics; (2) patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who receive trimethoprim-sulfamethoxazole or if human leukocyte antigen (HLA)-B*5701+ and receive the antiretroviral agent abacavir; (3) other genetically susceptible populations, e.g., Han-Chinese with HLA-B*1502+ who develop Stevens-Johnson syndrome and toxic epidermal necrolysis from carbamazepine, with HLA-B*5801+ who are at increased risk for such reactions from allopurinol, those with HLA-A*32:01 and receive vancomycin and develop drug reaction with eosinophilia and systemic symptoms syndrome; and (4) patients with a history of compatible allergic reactions to the same medication, similar class, or potentially unrelated medication. Specific patient groups at higher risk for drug allergy include patients with Epstein-Barr virus infection, chronic lymphatic leukemia, HIV/AIDS, cystic fibrosis, patients with seizures who are being treated with anti-epileptic medications, and patients with asthma (especially severe asthma) who are at increased risk of anaphylaxis from any cause, including drugs, compared with patients without asthma. In patients with a history of penicillin allergy, skin testing helps clarify the current level of risk for anaphylaxis by using the major (penicilloyl polylysine) and minor penicillin determinants in which sensitivity is 99%. If penicilloyl polylysine and penicillin G are used for skin testing, then the sensitivity is approximately 85-95%. When skin test results are negative, graded challenges are performed to administer optimal or truly essential antibiotics.
Topics: Bronchial Provocation Tests; Drug Hypersensitivity; Genetic Predisposition to Disease; Humans; Risk Factors; Skin Tests
PubMed: 31690398
DOI: 10.2500/aap.2019.40.4275 -
The Journal of Allergy and Clinical... Feb 2023
Topics: Humans; Drug Hypersensitivity
PubMed: 36759079
DOI: 10.1016/j.jaip.2022.11.013 -
Annals of Allergy, Asthma & Immunology... Jun 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Drug Hypersensitivity; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32448437
DOI: 10.1016/j.anai.2020.04.012 -
Clinical Reviews in Allergy & Immunology Jun 2022Hypersensitivity reactions (HSRs) to chemotherapy may prevent patients from receiving the most effective therapy. This review was undertaken to identify evidence-based... (Review)
Review
Hypersensitivity reactions (HSRs) to chemotherapy may prevent patients from receiving the most effective therapy. This review was undertaken to identify evidence-based preventive premedication strategies that reduce the likelihood of HSR in the first instance and improve the safety of subsequent infusions in patients who have demonstrated HSR to a certain class of chemotherapy. PubMed was searched until October 2021 using the key words: "hypersensitivity to chemotherapeutic drugs," "hypersensitivity to antineoplastic agents," "taxanes hypersensitivity," "platinum compound hypersensitivity," "premedication," "dexamethasone," "prednisone," "hydrocortisone," "antihistamine," "diphenhydramine," "cetirizine," "famotidine," "meperidine," "aspirin," "ibuprofen," and "montelukast." The search was restricted to articles published in English. A total of 73 abstracts were selected for inclusion in the review. Most premedication regimens have been derived empirically rather than determined through randomized trials. Based on the available evidence, we provide an update on likely HSR mechanisms and a practical guide for classifying systemic HSR. The evidence indicates that a combination of prevention strategies using newer antihistamines, H2 antagonists, leukotriene receptor antagonists, and corticosteroids and other interventions used judiciously reduces the occurrence and severity of HSR and improves safety.
Topics: Drug Hypersensitivity; Histamine Antagonists; Humans; Paclitaxel; Premedication; Taxoids
PubMed: 35258842
DOI: 10.1007/s12016-022-08932-2 -
Current Pharmaceutical Design 2023Drug hypersensitivity is increasing worldwide as the consumption of drug is increasing. Many clinical presentations of drug hypersensitivity are complex and take place... (Review)
Review
Drug hypersensitivity is increasing worldwide as the consumption of drug is increasing. Many clinical presentations of drug hypersensitivity are complex and take place in the setting of illness and/or polypharmacotherapy. To review the most recent findings in the diagnosis and management of immediate drug hypersensitivity reactions. Studies were selected based on their relevance, originality and date of publication. The understanding of endotypes, biomarkers and phenotypes has improved the categorization of immediate hypersensitivity reactions. In this review, we discussed the short- and long-term management of anaphylaxis with a special focus on in vivo and in vitro diagnostic methods. Moreover, the clinical management of drug-induced anaphylaxis, the role of hidden allergens and the importance of delabeling are discussed. Endophenotyping is crucial to correctly diagnose and treat patients with immediate drug hypersensitivity reactions, preventing future episodes through drug desensitization.
Topics: Humans; Anaphylaxis; Drug Hypersensitivity; Hypersensitivity, Immediate; Biomarkers; Allergens; Skin Tests
PubMed: 36284381
DOI: 10.2174/1381612829666221024154951 -
The Journal of Allergy and Clinical... Jun 2023
Topics: Humans; Food Hypersensitivity; Drug Hypersensitivity
PubMed: 37295861
DOI: 10.1016/j.jaip.2023.03.048 -
The Journal of Allergy and Clinical... Dec 2023Across all settings, women self-report more drug allergies than do men. Although there is epidemiologic evidence of increased drug allergy labeling in postpubertal... (Review)
Review
Across all settings, women self-report more drug allergies than do men. Although there is epidemiologic evidence of increased drug allergy labeling in postpubertal females, the evidence base for female sex as a risk factor for true immune-mediated drug hypersensitivity reactions (DHRs), particularly in fatal drug-induced anaphylaxis, is low. A focus on the known immunologic mechanisms described in immediate and delayed DHR, layered on known hormonal and genetic sex differences that drive other immune-mediated diseases, could be the key to understanding biological sex variations in DHR. Particular conditions that highlight the impact of drug allergy in women include (1) pregnancy, in which a drug allergy label is associated with increased maternal and fetal complications; (2) multiple drug intolerance syndrome, associated with anxiety and depression; and (3) female-predominant autoimmune medical conditions in the context of mislabeling of the drug allergy or increased underlying risk. In this review, we describe the importance of drug allergy in the female population, mainly focusing on the epidemiology and risk, the mechanisms, and the associated conditions and psychosocial factors. By performing a detailed analysis of the current literature, we provide focused conclusions and identify existing knowledge gaps that should be prioritized for future research.
Topics: Pregnancy; Female; Humans; Male; Drug Hypersensitivity; Anaphylaxis; Risk Factors; Self Report; Sex Characteristics; Anti-Bacterial Agents; Penicillins
PubMed: 37805007
DOI: 10.1016/j.jaip.2023.09.031 -
The Medical Clinics of North America Jan 2020Drug hypersensitivity reactions (DHRs) may be classified based on timing (immediate vs delayed), mechanisms, and pattern of clinical manifestations. Management may... (Review)
Review
Drug hypersensitivity reactions (DHRs) may be classified based on timing (immediate vs delayed), mechanisms, and pattern of clinical manifestations. Management may include selection of alternative, non-cross reactive agents, drug allergy testing, graded challenge and/or desensitization. Immediate skin testing only identifies risk for immediate-type allergic DHR and has a negative predictive value for only a limited number of drugs (eg, penicillin). Desensitization induces a temporary state of tolerance that is maintained only so long as the drug is continued. This article discusses special considerations about antibiotics, angiotensin-converting enzyme inhibitors, anesthetic agents, aspirin and nonsteroidal antiinflammatory drugs, radiocontrast media, and chemotherapeutic agents.
Topics: Anesthetics; Angiotensin-Converting Enzyme Inhibitors; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Predictive Value of Tests; Skin Tests
PubMed: 31757230
DOI: 10.1016/j.mcna.2019.09.003 -
JAMA Internal Medicine Aug 2023
Topics: Humans; Penicillins; Drug Hypersensitivity; Clinical Decision-Making; Hypersensitivity; Anti-Bacterial Agents; Skin Tests
PubMed: 37338869
DOI: 10.1001/jamainternmed.2023.1572 -
Allergy Jan 2022Biologicals are crucial targeted therapeutic agents in oncological, immunological, and inflammatory diseases, and their use in clinical practice is broadening. In recent...
Biologicals are crucial targeted therapeutic agents in oncological, immunological, and inflammatory diseases, and their use in clinical practice is broadening. In recent years, the spread of Personalized Precision Medicine has facilitated a proliferation of new treatment options, especially biologicals. Consequently, biologicals are now among the drugs that most frequently cause hypersensitivity reactions (HSRs). Patients can develop HSRs to these agents during the first-lifetime exposure or after repeated exposure, and these HSRs can be potentially life-threatening or limit therapeutic options. Despite the relatively high prevalence, the underlying mechanisms of these HSRs remain obscure, and the optimal management pathways are still a matter of discussion. In this Position Paper, the authors will provide evidence-based recommendations for diagnosing and managing HSRs to biologicals. Additionally, the document defines unmet needs as an opportunity to shape future research.
Topics: Antineoplastic Agents; Biological Products; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Precision Medicine
PubMed: 34157134
DOI: 10.1111/all.14984