Controversies in drug allergy

In vitro testing

Cristobalina Mayorga, Didier G. Ebo, David M. Lang, Werner J. Pichler, Vito Sabato, Miguel Park, Joanna Makowska, Marina Atanaskovic-Markovic, Patrizia Bonadonna, Edgardo Jares

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Despite their low frequency, drug hypersensitivity reactions (DHRs) can be serious and result in lifelong sequelae. The diagnosis is critical to avert future reactions and should identify the culprit drug or drugs and safe alternatives. However, making the diagnosis can be complex and challenging. Reliable in vitro tests can offer the potential to improve a diagnosis of DHR and influence medical decision making. Importantly, in vitro testing is frequently not performed as a test in isolation but rather as a component of a diagnostic algorithm along with additional tests. There are several in vitro approaches for the different endotypes of DHRs. However, only few are available for routine diagnosis, and many are restricted to research laboratories. In vitro tests exhibit varying sensitivity and specificity depending on the drug involved and the clinical phenotype. In vitro tests can complement skin tests, especially in patients with negative or equivocal skin test responses inconsistent with the clinical presentation and in severe reactions in which drug provocation tests are contraindicated. The main unmet need for many in vitro tests for the diagnosis of DHRs is validation in larger studies with standardized controls that could harmonize diagnostic management between the United States, European Union, and other regions of the world.

Original languageEnglish (US)
Pages (from-to)56-65
Number of pages10
JournalJournal of Allergy and Clinical Immunology
Volume143
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Drug Hypersensitivity
Skin Tests
Pharmaceutical Preparations
European Union
In Vitro Techniques
Phenotype
Sensitivity and Specificity
Research

Keywords

  • anaphylaxis
  • cytokine
  • diagnostic
  • Drug hypersensitivity
  • IgE
  • in vitro tests
  • p-i concept
  • proliferation
  • severe cutaneous reactions
  • T-cells

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Mayorga, C., Ebo, D. G., Lang, D. M., Pichler, W. J., Sabato, V., Park, M., ... Jares, E. (2019). Controversies in drug allergy: In vitro testing. Journal of Allergy and Clinical Immunology, 143(1), 56-65. https://doi.org/10.1016/j.jaci.2018.09.022

Controversies in drug allergy : In vitro testing. / Mayorga, Cristobalina; Ebo, Didier G.; Lang, David M.; Pichler, Werner J.; Sabato, Vito; Park, Miguel; Makowska, Joanna; Atanaskovic-Markovic, Marina; Bonadonna, Patrizia; Jares, Edgardo.

In: Journal of Allergy and Clinical Immunology, Vol. 143, No. 1, 01.01.2019, p. 56-65.

Research output: Contribution to journalReview article

Mayorga, C, Ebo, DG, Lang, DM, Pichler, WJ, Sabato, V, Park, M, Makowska, J, Atanaskovic-Markovic, M, Bonadonna, P & Jares, E 2019, 'Controversies in drug allergy: In vitro testing', Journal of Allergy and Clinical Immunology, vol. 143, no. 1, pp. 56-65. https://doi.org/10.1016/j.jaci.2018.09.022
Mayorga, Cristobalina ; Ebo, Didier G. ; Lang, David M. ; Pichler, Werner J. ; Sabato, Vito ; Park, Miguel ; Makowska, Joanna ; Atanaskovic-Markovic, Marina ; Bonadonna, Patrizia ; Jares, Edgardo. / Controversies in drug allergy : In vitro testing. In: Journal of Allergy and Clinical Immunology. 2019 ; Vol. 143, No. 1. pp. 56-65.
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