EAACI position paper on how to classify cutaneous manifestations of drug hypersensitivity

Brockow, Knut; Ardern‐Jones, Michael R.; Mockenhaupt, Maja; Aberer, Werner; Barbaud, A.; Caubet, Jean-Christoph Roger J-P; Śpiewak, Radosław; Torres, Marı́a José; Mørtz, Charlotte G.

doi:10.1111/all.13562

Cited by 186 publications

(205 citation statements)

References 47 publications

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“…2 Besides, an increase in severe cutaneous adverse reactions (SCARs) among children (reaching 100 cases/year) has been observed, probably due to the active pharmacovigilance programmes. 3 DHRs are clinically classified as immediate reactions (IRs) (1-6 hours afterdrugintake) causing urticaria, angioedema, or anaphylaxis, 4 or nonimmediate reactions (NIRs) (>1 hour after drug intake), ranging from maculopapular exanthema or fixed drug eruption (FDE) to SCARs such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) or single-organ reactions such as drug-induced liver disease (DILI) and drug-specific reactions such as abacavir hypersensitivity syndrome 2,5 (Table 1).…”

Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

“…[62][63][64][65] Precise definitions and provision of background, in a standardized available questionnaire, are helpful to correctly classify DHRs. 5,66,67 Although in NSAID hypersensitivity, the current classification needs a revision 68,69 including new entities as blended reactions. 55 Predictive models have been designed for the diagnosis of BL allergy, based only on clinical history.…”

Section: Iag Nos Ismentioning

confidence: 99%

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Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

Section: Iag Nos Ismentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…Our study is the largest one to investigate cross‐reactivity among BL antibiotics in non‐immediate CADRs including severe CADRs (Table ) . It is also the first one with a clearly late notified delay of onset for patients with MPE …”

Section: Discussionmentioning

confidence: 99%

“…Many studies have been published on cross‐reactivity in patients with IgE‐mediated immediate hypersensitivity to BL, for which intradermal tests (IDRs) have high sensitivity and specificity . Non‐immediate CADRs have been defined as onset occurring more than 1 hr after drug intake and mostly more than 1 day for MPE . Non‐immediate CADRs include then a wide spectrum of CADRs, from late urticaria occurring a few hours after drug intake to maculopapular exanthema (MPE) and severe CADRs.…”

Section: Introductionmentioning

confidence: 99%

Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Bérot¹,

Géner²,

Ingen‐Housz‐Oro

et al. 2019

Acad Dermatol Venereol

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Background Cross‐reactivity among beta‐lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives To evaluate cross‐reactivity beyond BLs in patients with non‐immediate cutaneous adverse drug reaction (non‐immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods We conducted a retrospective single‐centre study in consecutive patients consulting between 2010 and 2018 with an active BL‐suspected non‐immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P‐IDR)] for at least three penicillin's subclasses and amino‐ and non‐amino‐cephalosporins (at least one aminocephalosporin). Cross‐reactivity among subclasses was investigated for patients with positive tests. Results We included 56 patients, among whom 46 amoxicillin‐suspected were and seven cephalosporin‐suspected. Twenty‐nine had severe CADR, and 27 had non‐immediate maculopapular exanthema (MPE). Twenty‐two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin‐suspected, 10 (55.6%) showed cross‐reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non‐aminocephalosporin. No amoxicillin‐ or cephalosporin‐suspected patient showed cross‐reactivity with aztreonam or carbapenems. P‐IDR showed cross‐reactivity only once. Conclusion After a suspected BL‐induced non‐immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross‐reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross‐reactivity was frequent and PT was sufficient to this purpose. The frequent cross‐reactivity among penicillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross‐allergies are rarer.

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“…136 DHRs constitute an important health problem, affecting more than 7% of the population, 137 for whom drugs, such as beta-lactam antibiotics and nonsteroidal anti-inflammatory drugs, are essential for treatment of common diseases. 138,139 Based on the clinical characteristics of DHRs, different phenotypes have been identified, 137 although the lack in understanding the underlying mechanisms of many DHRs has hampered the definition of endotypes and identification of biomarkers. 140,141 The classification of DHRs based on the time elapsed between drug administration and development of symptoms is still a matter of debate, because it is difficult to establish a cutoff point to distinguish between immediate and nonimmediate DHRs.…”

Section: New Approaches To the Diagnosis And Treatment Of Drug Hypementioning

confidence: 99%

Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care

Breiteneder

Diamant

Eiwegger

et al. 2019

Allergy

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This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. AbstractThe specialties of allergy and clinical immunology have entered the era of precision medicine with the stratification of diseases into distinct disease subsets, specific diagnoses, and targeted treatment options, including biologicals and small molecules.This article reviews recent developments in research and patient care and future trends in the discipline. The section on basic mechanisms of allergic diseases summarizes the current status and defines research needs in structural biology, type 2 inflammation, immune tolerance, neuroimmune mechanisms, role of the microbiome and diet, environmental factors, and respiratory viral infections. In the section on diagnostic challenges, clinical trials, precision medicine and immune monitoring Zuzana Diamanthttps://orcid.org/0000-0003-0133-0100Thomas Eiwegger https://orcid.org/0000-0002-2914-7829Wytske J. Fokkens https://orcid.org/0000-0003-4852-229X

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EAACI position paper on how to classify cutaneous manifestations of drug hypersensitivity

Abstract: All named authors were involved consensus group meetings, retrival of information of drug allergy documentation in different countries and in the discussion and approval of the final manuscript.

Cited by 186 publications

References 47 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care

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