Drug Hypersensitivity Reactions: Diagnosis and Treatment (Part II)

Česká verzia

Authors: J. Nemšovská
Authors place of work: Dermatovenerologická klinika LF UK a UNB, Bratislava, prednostka prof. MUDr. Mária Šimaljaková, PhD., MPH, MHA
Published in the journal: Čes-slov Derm, 94, 2019, No. 5, p. 192-201
Category: Reviews (Continuing Medical Education)

Summary

The diagnosis of drug hypersensitivity reactions (DHRs) is primarily based on a thorough case history, skin tests and drug provocation tests (challenge tests) in indicated cases. Skin tests are integral to the culprit drug diagnostics. Skin prick tests (SPT) and intradermal tests (IDT) are recommended for immediate-type hypersensitivity reactions and patch test and late-reading IDT for delayed-type hypersensitivity reactions. In vitro tests can provide valuable additional information and yield decisive results for the diagnosis, especially in cases of severe drug reactions, when provocation tests are contraindicated. In vitro tests can either help to diagnose the DHR itself or to identify the culprit drug. Determination of tryptase, histamine and its metabolits, PAF (Platelet activating factor) and CPA3 (Carboxypeptidase A3) in immediate- -type DHRs and the cellular analysis of skin biopsies and peripheral blood in delayed-type DHRs belong to the first group of tests. The most commonly used tests to identify the culprit drug is determination of specific IgE, Basophil activation test, Lymphocyte transformation test and HLA allele determination. Treatment is based on permanent avoidance of the culprit drug and replacement for a structurally different, non-cross-reacting compound if needed. Drug desensitization represents a treatment option in cases, where there is no alternative drug available.

Keywords:

diagnosis – drug hypersensitivity – skin test – in vitro test – provocation test – desensitization

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