Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries

Abstract

Background: The issues and challenges in the diagnosis of drug allergy/hypersensitivity among children and adults in Asia are likely to be different from non-Asian countries. Objective: To study the diagnostic modalities used in the evaluation and management of drug allergy/drug hypersensitivity reactions (DHRs) among member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI). Methods: A questionnaire comprising 41 questions was circulated electronically to member societies and individual members of APAAACI between January 23, 2020 and March 6, 2020. Results: Twenty-six respondents from 15 member societies and 1 individual member responded. European DHR guidelines were most commonly used. Skin prick and intradermal testing was used by 100%, with only 60% having access to commercial penicillin skin test reagents. In vitro-specific IgE tests were used by 75%, and basophil activation test by 56.3% for immediate DHR. Patch tests were used by 75% in contrast to lymphocyte transformation tests by 25% for nonimmediate DHR. Drug provocation tests were used by 68.8%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (93.3%). Human leukocyte antigen (HLA) genotype testing was mandatory among 25% respondents before new carbamazepine prescriptions, and 8.3% for allopurinol prescriptions. Conclusions: There was increased use of skin testing for iodinated contrast media hypersensitivity and patch testing for nonimmediate DHR. HLA genotype testing prior to new carbamazepine, allopurinol and abacavir prescriptions remain variable despite strong associations for severe cutaneous adverse reactions with Asian ethnicity. Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across APAAACI member societies.

Translational Pharmacogenomics: Discovery, Evidence Synthesis and Delivery of Race‐Conscious Medicine

“…It is important to note that a recent survey identified a knowledge gap among pediatric neurologists in recognition of racial/ancestral differences in carbamazepine‐related SJS/TEN risk 78 . Similarly, a survey among members of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology societies revealed that only 25% of responders stated that HLA testing was mandatory before prescribing carbamazepine, and only 8.3% prior to prescribing allopurinol 79 . Despite strong evidence and recommendations reinforcing the increased risk of severe HSR in Asians, there is still a lack of clinical uptake and knowledge surrounding this risk.…”

GenotypingHLAalleles to predict the development of Severe cutaneous adverse drug reactions (SCARs): state-of-the-art

“…DHRs represent a significant public health problem with a prevalence of 10-20% in hospitalized patients and up to 7% in the general population exposed to drugs [76]. Tang et al surveyed the diagnostic modalities used in the evaluation and management of DHRs among member countries of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) which included respondents from five Southeast Asian countries [77]. The authors reported that HLA genotype testing before prescribing carbamazepine, allopurinol, and abacavir was not mandatory or recommended by local pharmacy regulatory agencies in the majority of countries despite strong associations for SCARs with Asian ethnicity.…”

It’s time for an evolution

“…The Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) is actively involved in the science and education of allergy, regional data generation and publications of white papers (white paper on climate change) [ 4 ] and surveys (drug allergy) [ 5 ] on various health and disease areas including asthma, immunotherapy, food allergy, microbiome etc., consensus documents, its educational e-learning’s, web lectures, scientific publications in our Asia Pacific Allergy journal, scientific collaborations, training workshops and symposia and participation in global guidelines through partnerships with sister organizations. Through these we are building a framework to meet the challenge of the rising complexity of allergies in the Asian Pacific region…”