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Cross-reactivity among drugs: clinical problems
Antonino Romano1, Rosa-Maria Guéant-Rodriguez, Marinella Viola
1Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati 31, 00168 Rome, Italy. columbus.romano@linet.it
Toxicology
|March 16, 2005
Summary
Drug cross-reactivity, whether immunologic or non-allergic, poses clinical challenges. Diagnostic tests and graded challenges help determine safe alternative medications when cross-reactivity is suspected.
Area of Science:
- Pharmacology
- Immunology
- Clinical Medicine
Background:
- Drug cross-reactivity can be immunologically mediated via common antigenic determinants.
- Non-allergic cross-reactivity involves shared pharmacological traits, like NSAIDs inhibiting cyclooxygenase-1 or muscle relaxants releasing histamine.
Purpose of the Study:
- To review the mechanisms of drug cross-reactivity.
- To discuss diagnostic approaches for assessing drug cross-reactivity.
- To highlight the clinical significance of choosing alternative drugs.
Main Methods:
- Review of immunologic and non-immunologic mechanisms of drug cross-reactivity.
- Discussion of diagnostic tests including skin testing, intradermal tests, patch tests, and lymphocyte transformation tests.
- Emphasis on graded drug challenges for assessing tolerability.
Main Results:
- Cross-reactivity mechanisms differ based on whether they are immunologic or non-allergic.
- Various in vivo and in vitro tests exist to evaluate specific types of drug cross-reactivity.
- Graded challenges are recommended when other diagnostic tests are negative due to limited sensitivity.
Conclusions:
- Understanding drug cross-reactivity is crucial for patient safety.
- Appropriate diagnostic testing aids in selecting alternative medications.
- Graded challenges offer a prudent approach to confirm drug tolerability in high-risk patients.