An Updated Review of the Diagnostic Methods in Delayed Drug Hypersensitivity

Frontiers in Pharmacology

Andrew Gibson¹  Ana Copaescu²  Elizabeth J. Phillips³  Yueran Li⁶  Jason A. Trubiano⁸ 

[1] Clinical Immunology and Allergy, McGill University Health Center, Montréal, Canada;Department of Infectious Diseases, Austin Health, Center for Antibiotic Allergy and Research, Heidelberg, VIC, Australia;Department of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States;Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, VIC, Australia;Department of Oncology, Sir Peter MacCallum Cancer Center, The University of Melbourne, Parkville, VIC, Australia;Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia;Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia;The National Center for Infections in Cancer, Peter MacCallum Cancer Center, Melbourne, VIC, Australia;

关键词: delayed hypersensitivity reaction;    drug allergy;    severe cutaneous adverse reactions;    T cells;    skin testing;    lymphocyte transformation test (LTT);   

DOI  :  10.3389/fphar.2020.573573

来源: DOAJ

【 摘 要 】

Delayed drug hypersensitivity reactions are clinically diverse reactions that vary from isolated benign skin conditions that remit quickly with no or symptomatic treatment, drug discontinuation or even continued drug treatment, to the other extreme of severe cutaneous adverse reactions (SCARs) that are associated with presumed life-long memory T-cell responses, significant acute and long-term morbidity and mortality. Diagnostic “in clinic” approaches to delayed hypersensitivity reactions have included patch testing (PT), delayed intradermal testing (IDT) and drug challenges for milder reactions. Patch and IDT are, in general, performed no sooner than 4–6 weeks after resolution of the acute reaction at the maximum non-irritating concentrations. Functional in vitro and ex vivo assays have largely remained the province of research laboratories and include lymphocyte transformation test (LTT) and cytokine release enzyme linked ImmunoSpot (ELISpot) assay, an emerging diagnostic tool which uses cytokine release, typically IFN-γ, after the patient’s peripheral blood mononuclear cells are stimulated with the suspected drug(s). Genetic markers such as human leukocyte antigen have shown recent promise for both pre-prescription screening as well as pre-emptive and diagnostic testing strategies.

【 授权许可】

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