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

Abstract

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.

Knowledge mapping and global trends of drug hypersensitivity from 2013 to 2023: A bibliometric analysis

“…The diagnosis of drug hypersensitivity aims to provide a safety guarantee for patients' clinical medication and reduce risk. Moreover, diagnosis is extremely complicated and highly dependent on the mechanisms involved 45 . From a practical perspective, drug hypersensitivity diagnosis can be performed by clinical history combined with in vivo and in vitro tests depending on the type of reactions (IDHR and NIDHR) 5,46 …”

“…Moreover, diagnosis is extremely complicated and highly dependent on the mechanisms involved. 45 From a practical perspective, drug hypersensitivity diagnosis can be performed by clinical history combined with in vivo and in vitro tests depending on the type of reactions (IDHR and NIDHR). 5,46 A detailed medical history of drug hypersensitivity is the first step for allergy specialists to evaluate.…”

Changing patterns in the epidemiology of drug allergy

“…Delayed reactions 61 can be skin‐limited benign reactions associated with long lasting T‐cell memory, single organ toxicity due to nonimmune cell‐receptor interactions, immune complex‐mediate serum sickness‐like reactions, cytotoxic IgG‐mediated reactions, and SCARS such as (DRESS), SJS and TEN, AGEP some of which have been shown to be human leukocyte antigen (HLA) class I alleles restricted 62,63 (Figure 1; Tables 1 and 2) and not amenable to desensitization. In vivo biomarkers 64 include skin testing by skin prick and intradermal methods, patch testing and drug challenges 7,65–67 and in vitro tests include tryptase, interleukin (IL)‐6, basophil activation test (BAT), mast cell activation test (MAT), nanoparticles and genotyping 58,68–75 (Figure 1).…”