Delayed hypersensitivity to antiepileptic drugs in children

Mori, Francesca; Blanca‐López, Natalia; Caubet, Jean-Christoph Roger J-P; Demoly, Pascal; Toit, George Du; Gomes, Eva; Kuyucu, Semanur; Romano, Antonino; Soyer, Özge; Tsabouri, Sophia; Atanasković-Marković, Marina

doi:10.1111/pai.13409

Cited by 11 publications

(6 citation statements)

References 111 publications

(322 reference statements)

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“…Regarding clinical manifestations, sensitivity and specificity are higher in MPE, FDE, AGEP and DRESS than in SJS/TEN [ 90 , 96 ]. Interestingly, lymphocyte transformation test results have shown a good correlation with the algorithm of drug causality for the epidermal necrolysis (ALDEN) score, suggesting its usefulness for diagnosing severe reactions [ 97 , 98 ]. Moreover, its use to evaluate drug cross-reactivity [ 99 ] and to confirm the culprit drug in SJS/TEN cases with multiple drug therapy should be highlighted [ 98 ].…”

Section: The Role Of In Vitro Tests In Antibiotic Allergy De-labelingmentioning

confidence: 99%

Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance

et al. 2022

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Antibiotics are one of the most frequently prescribed drugs. Unfortunately, they also are the most common cause for self-reported drug allergy, limiting the use of effective therapies. However, evidence shows that more than 90% of patients labeled as allergic to antibiotics are not allergic. Importantly, the label of antibiotic allergy, whether real or not, constitutes a major public health problem as it directly impacts antimicrobial stewardship: it has been associated with broad-spectrum antibiotic use, often resulting in the emergence of bacterial resistance. Therefore, an accurate diagnosis is crucial for de-labeling patients who claim to be allergic but are not really allergic. This review presents allergy methods for achieving successful antibiotic allergy de-labeling. Patient clinical history is often inaccurately reported, thus not being able to de-label most patients. In vitro testing offers a complementary approach but it shows limitations. Immunoassay for quantifying specific IgE is the most used one, although it gives low sensitivity and is limited to few betalactams. Basophil activation test is not validated and not available in all centers. Therefore, true de-labeling still relies on in vivo tests including drug provocation and/or skin tests, which are not risk-exempt and require specialized healthcare professionals for results interpretation and patient management. Moreover, differences on the pattern of antibiotic consumption cause differences in the diagnostic approach among different countries. A multidisciplinary approach is recommended to reduce the risks associated with the reported penicillin allergy label.

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Section: The Role Of In Vitro Tests In Antibiotic Allergy De-labelingmentioning

confidence: 99%

Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance

et al. 2022

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“…Finally, LTT results demonstrated a good correlation with the algorithm of drug causality for epidermal necrolysis (ALDEN) score, indicating the role of this method for diagnosing severe HSR. 24 , 25 …”

Section: In Vitro Tools For the Diagnosis Of Hsr To Drugs What's New ...mentioning

confidence: 99%

Drug hypersensitivity, in vitro tools, biomarkers, and burden with COVID‐19 vaccines

Palomares

Paris

Labella

et al. 2022

Allergy

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Hypersensitivity reactions to drugs are increasing worldwide. They display a large degree of variability in the immunological mechanisms involved, which impacts both disease severity and the optimal diagnostic procedure. Therefore, drug hypersensitivity diagnosis relies on both in vitro and in vivo assessments, although most of the methods are not well standardized. Moreover, several biomarkers can be used as valuable parameters for precision medicine that provide information on the endotypes, diagnosis, prognosis, and prediction of drug hypersensitivity development, as well on the identification of therapeutic targets and treatment efficacy monitoring. Furthermore, in the last 2 years, the SARS‐CoV‐2 (severe acute respiratory syndrome‐coronavirus) pandemic has had an important impact on health system, leading us to update approaches on how to manage hypersensitivity reactions to drugs used for its treatment and on COVID‐19 (Coronavirus disease) vaccines used for its prevention. This article reviews recent advances in these 3 areas regarding drug hypersensitivity: in vitro tools for drug hypersensitivity diagnosis, recently identified biomarkers that could guide clinical decision making and management of hypersensitivity reactions to drugs and vaccines used for COVID‐19.

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“…Individuals with specific HLA haplotypes are predisposed to develop DRESS. The most common implicated drugs include antiepileptics, allopurinol, sulfonamides, BL and dapsone [5 ▪▪ ,6 ▪▪ ,8,24–26]. The pathophysiology is thought to be a T-cell-mediated hypersensitivity reaction type IVb (Coombs and Gell classification) with increased IL-5 expression and increased eosinophil number and their activation and recruitment to the affected tissues [3 ▪▪ ,8].…”

Section: Drug Reaction With Eosinophilia and Systemic Symptomsmentioning

confidence: 99%

“…[24][25][26]. The pathophysiology is thought to be a T-cell-mediated hypersensitivity reaction type IVb (Coombs and Gell classification) with increased IL-5 expression and increased eosinophil number and their activation and recruitment to the affected tissues [.…”

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confidence: 99%

Exanthematous reactions to drugs in children

Atanasković-Marković

Tsabouri

2021

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewThe true exanthematous reactions to drugs in children are rare and overdiagnosed. Drugs may cause exanthema either due to inducing an immune response or because of their interaction with viruses, if drugs are taken in the course of a viral infection. Also, viral infections are very often in children and they can provoke an exanthema which is difficult to differentiate from exanthematous reactions to drugs. Consequently, the majority of children are incorrectly labeled as 'allergic'. Recent findingsThe correct diagnosis of exanthematous drug reactions in children is still an important and hot topic. Most information about the approach and management of drug hypersensitivity in children is applied from available guidelines and consensus statement for adults. Recently, a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous exanthema while receiving a drug, is proposed.

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Delayed hypersensitivity to antiepileptic drugs in children

Cited by 11 publications

References 111 publications

Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance

Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance

Drug hypersensitivity, in vitro tools, biomarkers, and burden with COVID‐19 vaccines

Exanthematous reactions to drugs in children

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