Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19

Abstract

Coronavirus disease 2019 (COVID-19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID-19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off-label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings together all the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off-label drugs and highlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactions in the course of the disease.

A compendium answering over 140 questions on COVID-19 and SARS-CoV-2

“…145 These patients are also at increased risk of drug hypersensitivity lesions ( Figure 6 ). 146 Are patients with epithelial barrier disorders at higher risk of skin complications?…”

“…erythematous rash, urticaria, maculopapular exanthema). 146 Drug hypersensitivity has to be considered as a differential diagnosis, mainly in the second group, being a distinction difficult during the acute phase. Diagnosis relies mostly on clinical observations.…”

“…Most reactions are non-immediate and further studies are required to clarify whether this increased frequency is caused by the drug immunogenicity or simply derives from a greater consumption as compared to other treatments. 146…”

Complications of COVID-19 , a case with both neurological and dermatological complications.

“…This is considered as a nonimmediate hypersensitivity reaction, which is very rarely reported. (3,4) A therapy with antihistamine (hydroxyzine10) started for the patient and after 3 days, he presented with diplopia and ophthalmoplegia .…”

The complexity of drug hypersensitivity reactions

“…Gelincik A et al . 13 reviewed DHRs in COVID-19 times to these drugs, with knowledge mainly coming from previous clinical experience in patients not infected with COVID-19. As in other viral infections, skin symptoms, including exanthemas, may appear during the evolution of the disease, leading to differential diagnosis with DHRs.…”