An EAACI task force report: recognising the potential of the primary care physician in the diagnosis and management of drug hypersensitivity

Abstract

Adverse drug reactions include drug hypersensitivity reactions (DHRs), which can be immunologically mediated (allergy) or non-immunologically mediated. The high number of DHRs that are unconfirmed and often self-reported is a frequent problem in daily clinical practice, with considerable impact on future prescription choices and patient health. It is important to distinguish between hypersensitivity and non-hypersensitivity reactions by adopting a structured diagnostic approach to confirm or discard the suspected drug, not only to avoid life-threatening reactions, but also to reduce the frequent over-diagnosis of DHRs. Primary care physicians are often the first point of contact for the sufferer of a reaction, as such they have a key role in deciding whether to discard the diagnosis or send the patient for further investigation. In this review, we highlight the importance of diagnosing DHRs, analysing in detail the role of primary care physicians. We describe the common patterns of DHRs and signs of its progression, as well as the indications and contraindications for referring the patient to an allergist. The diagnostic process is described and the possible tests are discussed, which often depend on the drug involved and the type of DHR suspected. We also describe recommendations regarding the avoidance of medication suspected to have caused the reaction and the use of alternatives.

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

“…Current knowledge suggests that direct DPT may be done, without ST, in children reporting a history of delayed benign cutaneous reaction to BLs . Such approach is mainly validated in small children without a history of anaphylaxis nor of severe cutaneous reaction, when viral infections are the most important cause of non‐severe skin exanthemas.…”

The role of mobile health technologies in allergy care: An EAACI position paper

“…mHealth apps for drug allergy have been developed mainly for educational purposes to help distinguish adverse drug reactions between those which are pharmacologically explicable and those due to immediate or delayed hypersensitivity …”

“…mHealth apps for drug allergy have been developed mainly for educational purposes to help distinguish adverse drug reactions between those which are pharmacologically explicable and those due to immediate or delayed hypersensitivity. 90 Very few apps specifically dealing with drug allergy have been developed. Therefore, there is an urgent need for applications providing information in the following areas: different manifestations of drug hypersensitivity, drug interactions/cross-reactivity, common differential diagnoses, frequent elicitors of different types of drug hypersensitivity, and a list of brand names indicating related generic drugs in different countries.…”

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

“…147 Primary care physicians are often the first point of contact for patients with DHRs; thus, they have a key role in diagnosis and need specific training. 148 Although the specific treatment of DHRs is avoiding the drug involved and those chemically related, desensitization is nowadays a frequent option. [149][150][151] In that sense, rapid drug desensitization is a cost-effective technique that activates inhibitory mechanisms and permits patients to receive the first-choice medications to which they are allergic.…”