A Case of Sulfasalazine-Induced Hypersensitivity Syndrome Confirmed by Enzyme-Linked Immunospot Assay

Phatharacharukul, Parkpoom; Klaewsongkram, Jettanong

doi:10.4168/aair.2013.5.6.415

Cited by 16 publications

(6 citation statements)

References 11 publications

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“…The GrB ELISpot has a lower reported sensitivity (33%-55%) from smaller cases series (113,116), with similar specificity. Although a commonly defined threshold for ELISpot assays performed in triplicate has been 50 spots per million, there remains variability in the definition of a positive ELISpot assay, as outlined in Table E1, online repository (116,(137)(138)(139)(140)(141)(142)(143)(144)(145)(146)(147), likely impacting reported sensitivities. (148)(149)(150).…”

Section: In Vitro and Ex Vivo Diagnosticsmentioning

confidence: 99%

Delabeling Delayed Drug Hypersensitivity: How Far Can You Safely Go?

Lehloenya

Peter

Copascu

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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Delayed immune mediated adverse drug reactions (IM-ADRs) are defined as reactions occurring more than 6 hours after dosing. They include heterogenous clinical phenotypes that are typically T-cell mediated reactions with distinct mechanisms across a wide spectrum of severity from benign exanthems through to life-threatening cutaneous or organ-specific diseases. For mild reactions such as benign exanthem, considerations for delabeling are similar to immediate reactions, and may include graded or single dose drug challenge with or without preceding skin or patch testing. Evaluation of challenging cases such as the patient who is on multiple drugs at the *

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Section: In Vitro and Ex Vivo Diagnosticsmentioning

confidence: 99%

Delabeling Delayed Drug Hypersensitivity: How Far Can You Safely Go?

Lehloenya

Peter

Copascu

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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“…Unfortunately, the accuracy of the commercially available LTTs is unknown. The ELISpot assay has been introduced to confirm delayed drug reactions by detecting drug-specific cytokine release (interferon-gamma and IL-4) and has shown utility in isolated cases of DRESS [49,50].…”

Section: Assessment Of Drug Causalitymentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

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While peripheral or tissue eosinophilia may certainly characterize drug eruptions, this feature is hardly pathognomonic for a medication-induced etiology. While delayed drug hypersensitivity reactions with prominent eosinophilic recruitment have been typically classified as type IVb reactions, their pathophysiology is now known to be more complex. Eosinophilic drug reactions have a diversity of presentations and may be benign and self-limited to severe and life-threatening. The extent of clinical involvement is also heterogeneous, ranging from isolated peripheral eosinophilia or single organ involvement (most often the skin and lung) to systemic disease affecting multiple organs, classically exemplified by drug-reaction with eosinophilia and systemic symptoms (DRESS). The spectrum of implicated medications in the causation of DRESS is ever expanding, and multiple factors including drug metabolites, specific HLA alleles, herpes viruses, and immune system activation have been implicated in pathogenesis. Due to this complex interplay of various factors, diagnostic workup in terms of skin and laboratory testing has not been validated. Similarly, the lack of controlled trials limits treatment options. This review also describes other localized as well as systemic manifestations of eosinophilic disease induced by various medication classes, including their individual pathophysiology, diagnosis, and management. Given the multitude of clinical patterns associated with eosinophilic drug allergy, the diagnosis can be challenging. Considerable deficits in our knowledge of these presentations remain, but the potential for severe reactions should be borne in mind in order to facilitate diagnosis and institute appropriate management.

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“…El estudio de ciertos alelos del antígeno leucocitario humano (HLA-I) se han reportado como un factor de riesgo genético para las reacciones cutáneas severas a drogas específicas como es el caso de DRESS por alopurinol, lamotrigina y carbamazepina 12 , sin embargo, su influencia en el cuadro clínico aún se investiga. Un avance en los métodos diagnósticos es el ensayo de inmunospot ligado a enzimas (ELISpot) que detecta la liberación de interferón (IFN)-γ desde linfocitos estimulados específicamente con determinadas drogas, cuyo uso ha sido reportado en casos de DRESS por sulfasalazina 18,19 .…”

Section: Discussionunclassified