The Value of In Vitro Tests to Diminish Drug Challenges

Mayorga, Cristobalina; Doña, Inmaculada; Pérez‐Inestrosa, Ezequiel; Fernández, Tahía D.; Torres, Marı́a José

doi:10.3390/ijms18061222

Cited by 61 publications

(70 citation statements)

References 92 publications

(171 reference statements)

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“…27 Interestingly, these data are strongly influenced by the type of reaction, with mild and moderate reactions showing greater sensitivity (58% to 89%) [85][86][87][88] and specificity (93% to 100%) compared with data obtained in patients with severe bullous reactions (sensitivity range, 25% to 75%; specificity range, 63% to 100%). 27,[89][90][91][92] Positivity will depend on the drug tested, with higher results when evaluating anticonvulsant-induced DRESS 89,93-96 than SJS/ TEN. 90,93 Use of tritiated thymidine incorporation to measure cell proliferation can produce false-positive results when stimulating cells with some drugs, as demonstrated with methotrexate.…”

Section: Lttsmentioning

confidence: 97%

“…DHRs to b-lactams (BLs; using the major determinant, penicilloyl), NMBAs, quinolones, and biological agents have been evaluated in different studies. 18,27 Performance varies depending on the drug involved, with a range of positivity of 38% to 85% for BLs, [28][29][30][31][32] 44% to 92% for NMBAs, [33][34][35][36][37][38] 26% to 68% for biological agents, 39,40 and 59% to 75% for platins. 41 For BL hypersensitivity evaluation, the inclusion of all suspected drugs has been associated with an increase in sensitivity, as has been observed for patients with IDHRs to the combination of amoxicillin-clavulanic acid.…”

Section: Resolution Phasementioning

confidence: 99%

“…17,19 Histamine determination 61% to 92% 20,22 d This variability could be related to the type of reaction. 17,19 IDHRs at the resolution phase identifying the relevant drug sIgE by using immunoassay 38% to 85% for BLs [21][22][23][24][25] 44% to 92% for NMBAs [26][27][28][29][30][31][32] 26% to 68% for biological agents 39,40 59% to 75% for platins 41 d sIgE to penicillins can produce falsepositive results in patients with penicillin V allergy 120 and in those with high levels of total serum IgE. 121 BAT 44% to 63% for BLs 42,[47][48][49][50][51][52] 36% to 92% for NMBAs 35,36,[53][54][55][56][57][58] 42% to 65% for dipyrone [59][60][61] 57% to 77% for quinolones [62][63][64][65] 46% to 63% for RCM 66,...…”

Section: Expert Consensusmentioning

confidence: 99%

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Controversies in drug allergy: In vitro testing

Mayorga

Ebo

Lang

et al. 2019

Journal of Allergy and Clinical Immunology

Self Cite

102

106

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Despite their low frequency, drug hypersensitivity reactions (DHRs) can be serious and result in lifelong sequelae. The diagnosis is critical to avert future reactions and should identify the culprit drug or drugs and safe alternatives. However, making the diagnosis can be complex and challenging. Reliable in vitro tests can offer the potential to improve a diagnosis of DHR and influence medical decision making. Importantly, in vitro testing is frequently not performed as a test in isolation but rather as a component of a diagnostic algorithm along with additional tests. There are several in vitro approaches for the different endotypes of DHRs. However, only few are available for routine diagnosis, and many are restricted to research laboratories. In vitro tests exhibit varying sensitivity and specificity depending on the drug involved and the clinical phenotype. In vitro tests can complement skin tests, especially in patients with negative or equivocal skin test responses inconsistent with the clinical presentation and in severe reactions in which drug provocation tests are contraindicated. The main unmet need for many in vitro tests for the diagnosis of DHRs is validation in larger studies with standardized controls that could harmonize diagnostic management between the United States, European Union, and other regions of the world.

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Section: Lttsmentioning

confidence: 97%

Section: Resolution Phasementioning

confidence: 99%

Section: Expert Consensusmentioning

confidence: 99%

See 1 more Smart Citation

Controversies in drug allergy: In vitro testing

Mayorga

Ebo

Lang

et al. 2019

Journal of Allergy and Clinical Immunology

Self Cite

102

106

View full text Add to dashboard Cite

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“…Although in vitro tests are safer than in vivo tests, their validities are often questioned. Therefore, combining in vitro and in vivo tests is recommended for evaluation of drug allergy [13].…”

Section: Discussionmentioning

confidence: 99%

Suspected Local Anesthetic Allergy of a Child: A Case Report

Matsumura¹,

Miyamoto²,

Fukayama³

2017

Pediatr Dent Care

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In dental practice, a certain number of patients complain of various symptoms after injection of local anesthetics. However, especially in children who cannot express their symptoms properly, a correct diagnosis of local anesthetic allergy is difficult. Here is a case of a boy with suspected local anesthetic allergy. We looked for an alternative local anesthetic on the basis of the medical history and the results of allergy tests.

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“…Als In‐vitro‐Testverfahren für die Abklärung von Spättypreaktionen stehen aktuell der Lymphozytenproliferationstest (LTT), der Enzyme‐Linked Immunosorbent Spot (ELISpot) Assay sowie der Enzyme‐Linked Immunosorbent Assay (ELISA) zur Verfügung, mit denen antigenspezifische T‐Lymphozyten bzw. die von ihnen nach Stimulation produzierten Zytokine nachgewiesen werden können . Wegen des relativ hohen technischen Aufwands und der damit verbundenen Fehleranfälligkeit werden die Tests aber nur von spezialisierten Labors durchgeführt und sind bis heute überwiegend wissenschaftlichen Fragestellungen vorbehalten.…”

Section: In‐vivo‐ Und In‐vitro‐testverfahrenunclassified

Spättypreaktionen auf oral und parenteral verabreichte Arzneimittel

Brandt

Bircher

2017

J Deutsche Derma Gesell

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ZusammenfassungSpättypreaktionen auf Arzneimittel gehören zu den häufigsten Ursachen für Dermatosen überhaupt und manifestieren sich überwiegend in Form relativ harmloser exanthematischer, makulöser oder makulopapulöser Läsionen. Etwa zwei Prozent der betroffenen Patienten allerdings entwickeln schwere oder gar lebensbedrohliche, mit systemischen Immunreaktionen und damit verbundenen Organbeteiligungen einhergehende Reaktionen, die frühestmöglich erkannt und adäquat behandelt werden müssen. Zahlreiche Medikamente können Auslöser dieser Hypersensitivitätsreaktionen sein; Antibiotika, Antiepileptika und der Xanthinoxidase-Inhibitor Allopurinol sind die häufigsten. Neben einer genetischen Prädisposition gelten hohe Dosen, Behandlungen mit multiplen Arzneimitteln, lange Therapiezeiten, weibliches Geschlecht sowie akute oder chronische Infektionen als prädisponierende Faktoren. SummaryAdverse drug reactions of the delayed type rank among the most common dermatoses and are predominantly characterized by exanthematous macular or maculopapular eruptions. However, approximately 2 % of affected individuals develop severe or even life-threatening systemic immune reactions associated with organ involvement, requiring immediate diagnosis and treatment. Numerous drugs are capable of eliciting delayed-type hypersensitivity reactions, with antibiotics, anticonvulsant drugs, and the xanthine oxidase inhibitor allopurinol being the most common. Apart from genetic susceptibility, predisposing factors for the development of drug hypersensitivity reactions include high drug doses, polypharmacy, long treatment duration, female gender, as well as acute or chronic infections. Einleitung DefinitionHypersensitivitätsreaktionen sind gemäß einer Konsensuserklärung der World Allergy Organization (WAO) als objektiv reproduzierbare Symptome defi niert, die durch Exposition gegenüber einem bestimmten Stimulus in einer Dosis hervorgerufen werden, die von Normalpersonen problemlos toleriert wird. Demnach

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The Value of In Vitro Tests to Diminish Drug Challenges

Cited by 61 publications

References 92 publications

Controversies in drug allergy: In vitro testing

Controversies in drug allergy: In vitro testing

Suspected Local Anesthetic Allergy of a Child: A Case Report

Spättypreaktionen auf oral und parenteral verabreichte Arzneimittel

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