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Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America

Authors
  • Torres, M. J.1, 2
  • Romano, A.3, 4
  • Celik, G.5
  • Demoly, P.6
  • Khan, D. A.7
  • Macy, E.8
  • Park, M.9
  • Blumenthal, K.10
  • Aberer, W.11
  • Castells, M.12
  • Barbaud, A.13
  • Mayorga, C.14
  • Bonadonna, P.15
  • 1 IBIMA-Regional University Hospital of Malaga-UMA (Pavilion C), Allergy Unit, National Network ARADyAL, Plaza del Hospital Civil, Malaga, 29009, Spain , Malaga (Spain)
  • 2 BIONAND-Andalusian Centre for Nanomedicine and Biotechnology, Malaga, Spain , Malaga (Spain)
  • 3 Presidio Columbus, Allergy Unit, Rome, Italy , Rome (Italy)
  • 4 IRCCS Oasi Maria S.S., Troina, Italy , Troina (Italy)
  • 5 Ankara University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Ankara, Turkey , Ankara (Turkey)
  • 6 Equipe EPAR, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier and Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Paris, 75013, France , Paris (France)
  • 7 University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Allergy and Immunology, Dallas, TX, USA , Dallas (United States)
  • 8 Kaiser Permanente Health Care Program, San Diego, CA, USA , San Diego (United States)
  • 9 Mayo Clinic, Mayo Clinic College of Medicine, Division of Allergic Diseases, Rochester, MN, 55905, USA , Rochester (United States)
  • 10 Massachusetts General Hospital and Harvard Medical School, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Boston, MA, USA , Boston (United States)
  • 11 Medical University of Graz, Department of Dermatology, Graz, Austria , Graz (Austria)
  • 12 Brigham and Women’s Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MSA, USA , Boston (United States)
  • 13 Tenon Hospital (AP-HP), Sorbonne Universities, UPMC Univ Paris 06, Dermatology and Allergology Department, 4 rue de la chine, Paris, 75020, France , Paris (France)
  • 14 IBIMA-Regional University Hospital of Malaga-UMA (Pavilion C), Allergy Unit, Plaza del Hospital Civil, Malaga, 29009, Spain , Malaga (Spain)
  • 15 Allergy Unit, Azienda Ospedaliera Universitaria Intergrata of Verona, Verona, Italy , Verona (Italy)
Type
Published Article
Journal
Clinical and Translational Allergy
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Mar 13, 2017
Volume
7
Issue
1
Identifiers
DOI: 10.1186/s13601-017-0144-0
Source
Springer Nature
Keywords
License
Green

Abstract

Drug hypersensitivity reactions (DHRs) affect an unknown proportion of the general population, and are an important public health problem due to their potential to cause life-threatening anaphylaxis and rare severe cutaneous allergic reactions. DHR evaluations are frequently needed in both ambulatory and hospital settings and have a complex diagnosis that requires a detailed clinical history and other tests that may include in vitro tests and in vivo procedures such as skin tests and drug provocation tests. Although over the years both European and U.S. experts have published statements on general procedures for evaluating DHRs, a substantial discordance in their daily management exists. In this review, we highlight both the differences and the similarities between the European and U.S. perspectives. While a general consensus exists on the importance of skin tests for evaluating DHRs, concordance between Americans and Europeans exists solely regarding their use in immediate reactions and the fact that a confirmation of a presumptive diagnosis by drug provocation tests is often the only reliable way to establish a diagnosis. Finally, great heterogeneity exists in the application of in vitro tests, which require further study to be well validated.

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