Journal article
Delabeling delayed drug hypersensitivity: How far can you safely go?
The Journal of Allergy and Clinical Immunology: In Practice, Vol.8(9), pp.2878-2895.e6
2020
Abstract
Delayed 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.
Details
- Title
- Delabeling delayed drug hypersensitivity: How far can you safely go?
- Authors/Creators
- R.J. Lehloenya (Author/Creator)J.G. Peter (Author/Creator)A. Copascu (Author/Creator)J.A. Trubiano (Author/Creator)E.J. Phillips (Author/Creator)
- Publication Details
- The Journal of Allergy and Clinical Immunology: In Practice, Vol.8(9), pp.2878-2895.e6
- Publisher
- Elsevier
- Identifiers
- 991005541106207891
- Copyright
- © 2020 American Academy of Allergy, Asthma & Immunology
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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Source: InCites
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.265 Dermatology - Skin Allergies
- 1.265.1140 Drug Hypersensitivity
- Web Of Science research areas
- Allergy
- Immunology
- ESI research areas
- Clinical Medicine