Diagnostic patch testing following tuberculosis‐associated cutaneous adverse drug reactions induces systemic reactions in
            <scp>HIV</scp>
            ‐infected persons

Lehloenya, Rannakoe; Todd, Gail; Wallace, Jeffrey I.; Ngwanya, Mzudumile R.; Muloiwa, Rudzani; Dheda, Keertan

doi:10.1111/bjd.14492

Cited by 40 publications

(30 citation statements)

References 32 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Amongst HIV-infected patients with TB drug related SJS/TEN, we have described a high incidence of non-life threatening systemic reactions to PT (91). In addition, the negative predictive value of in-vivo drug skin testing for CADRs is only ~90%, depending on the drug tested, making a case for oral provocation challenge if safe and alternative treatments are not available (92).…”

Section: Managementmentioning

confidence: 99%

“…Based on current knowledge and experience, rechallenge in SCAR should be performed in a controlled environment with resuscitation facilities using established protocols (25). There is emerging evidence that oral drug provocation can be safe and feasible, even in life threatening conditions such as SJS/TEN and DRESS, if performed under close observation in hospital (100) (101). However, rechallenge is complex and needs a multidisciplinary team of experienced physicians.…”

Section: Managementmentioning

confidence: 99%

“…Off-target reactions that are non-immunologically mediated are often dose-dependent whereas immunologically-mediated off-target reactions associated with immunological memory can be both dose dependent (T-cell mediated reactions) or dose-independent (recognition and amplification of small amounts of antigen in the case of IgE-mediated reactions). Predisposition to both on-target and off-target reactions is driven by genetic variation but also ecological factors that can vary over the course of an individual’s lifetime (Adapted from White et al (101) and Phillips (127)…”

Section: Figurementioning

confidence: 99%

See 2 more Smart Citations

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

Peter

Lehloenya

Dlamini

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

111

View full text Add to dashboard Cite

The majority of immune-mediated adverse drug reactions (IM-ADRs) involve the skin, and many have additional systemic features. Severe cutaneous adverse drug reactions (SCAR) are an uncommon, potentially life-threatening and challenging sub-group of IM-ADRs with diverse clinical phenotypes, mechanisms and offending drugs. T-cell mediated immunopathology is central to these severe delayed reactions, but effector cells and cytokines differ by clinical phenotype. Strong HLA-gene associations have been elucidated for specific drug-SCAR IM-ADRs such as Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN); although the mechanisms by which carriage of a specific HLA allele is necessary but not sufficient for the development of many IM-ADRs is still being defined. SCAR management is complicated by substantial short and long-term morbidity/ mortality and the potential need to treat ongoing co-morbid disease with related medications. Multidisciplinary specialist teams at experienced units should care for patients. In the setting of SCAR, patient outcomes as well as preventive,diagnostic, treatment and management approaches are often not generalizable, but rather context specific, driven by population HLA-genetics, the pharmacology and genetic risk factors of the implicated drug, severity of underlying co-morbid disease necessitating ongoing treatments, and cost considerations. In this review, we update the basic and clinical science of SCAR diagnosis and management.

show abstract

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

Peter

Lehloenya

Dlamini

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

111

View full text Add to dashboard Cite

show abstract

“…They are related to T cell-mediated symptoms such as maculopapular exanthema or delayed urticaria and can also involve other organs such as liver, lungs, kidneys, or hematological alterations [1,8,13,24]. Severe Cutaneous Adverse Reactions (SCAR) which include Acute Generalized Exanthematous Pustulosis (AGEP), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) have a severe clinical presentation with different treatment and poor clinical outcomes [13,14].…”

Section: Drug Hypersensitivity Reactions: New Clinical Approach Thmentioning

confidence: 99%

“…Prescreening before abacavir treatment in HIV positive patients is required to identify potential reactors expressing HLA-B 57:01 [14]. To identify T-cell mediated hypersensitivity, diagnostic tools such as patch testing and lymphocyte transformation tests (LTT) have been proposed [1,24,33], and more recently, cytotoxic T-cell proteins such as granulysin, perforin, and granzyme B [34]. …”

Section: Drug Hypersensitivity Reactions: New Clinical Approach Thmentioning

confidence: 99%

Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches

Vecillas

Alenazy

Garcia-Neuer

et al. 2017

IJMS

104

View full text Add to dashboard Cite

Drug hypersensitivity reactions (HSRs) are increasing in the 21st Century with the ever expanding availability of new therapeutic agents. Patients with cancer, chronic inflammatory diseases, cystic fibrosis, or diabetes can become allergic to their first line therapy after repeated exposures or through cross reactivity with environmental allergens. Avoidance of the offending allergenic drug may impact disease management, quality of life, and life expectancy. Precision medicine provides new tools for the understanding and management of hypersensitivity reactions (HSRs), as well as a personalized treatment approach for IgE (Immunoglobuline E) and non-IgE mediated HSRs with drug desensitization (DS). DS induces a temporary hyporesponsive state by incremental escalation of sub-optimal doses of the offending drug. In vitro models have shown evidence that IgE desensitization is an antigen-specific process which blocks calcium flux, impacts antigen/IgE/FcεRI complex internalization and prevents the acute and late phase reactions as well as mast cell mediator release. Through a “bench to bedside” approach, in vitro desensitization models help elucidate the molecular pathways involved in DS, providing new insights to improved desensitization protocols for all patients. The aim of this review is to summarize up to date information on the drug HSRs, the IgE mediated mechanisms of desensitization, and their clinical applications.

show abstract

Drug Desensitization in Immediate-Type Hypersensitivity

Castells

Hamadi

Sanchez

2022

Cutaneous Drug Hypersensitivity

View full text Add to dashboard Cite

Diagnostic patch testing following tuberculosis‐associated cutaneous adverse drug reactions induces systemic reactions in HIV ‐infected persons

Abstract: In HIV-infected persons with tuberculosis-associated CADR, although patch-testing reactions to FLTD are common and tend to be associated with systemic features, they are not life threatening or fatal. These data inform clinical practice in HIV-endemic settings.

Cited by 40 publications

References 32 publications

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches

Drug Desensitization in Immediate-Type Hypersensitivity

Contact Info

Product

Resources

About