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Controversies in drug allergy: In vitro testing
Cristobalina Mayorga1, Didier G Ebo2, David M Lang3
1Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, ARADyAL, Malaga, Spain; Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, ARADyAL, Malaga, Spain.
The Journal of Allergy and Clinical Immunology
|December 22, 2018
Summary
Diagnosing drug hypersensitivity reactions (DHRs) is complex. In vitro tests show promise for improving DHR diagnosis and guiding treatment, but require further validation for routine use.
Area of Science:
- Clinical Immunology
- Pharmacology
- Diagnostic Medicine
Background:
- Drug hypersensitivity reactions (DHRs), though infrequent, can cause severe, lifelong health issues.
- Accurate diagnosis of DHRs is crucial for preventing future reactions and identifying safe drug alternatives.
- Current diagnostic methods can be complex and challenging, necessitating improved approaches.
Purpose of the Study:
- To evaluate the role and potential of in vitro tests in improving the diagnosis of DHRs.
- To explore how in vitro testing can influence clinical decision-making for patients with DHRs.
- To identify the limitations and unmet needs in the current diagnostic landscape for DHRs.
Main Methods:
- Review of existing in vitro diagnostic approaches for various DHR endotypes.
- Analysis of the performance (sensitivity and specificity) of in vitro tests across different drugs and clinical phenotypes.
- Comparison of in vitro tests with traditional methods like skin tests and drug provocation tests.
Main Results:
- In vitro tests offer potential for enhanced DHR diagnosis and can guide medical decisions.
- Several in vitro methods exist, but few are validated for routine clinical use, with many confined to research settings.
- In vitro tests can supplement skin tests, particularly in cases with inconclusive results or contraindications for provocation tests.
Conclusions:
- In vitro tests are valuable components of diagnostic algorithms for DHRs, complementing other methods.
- Wider adoption of in vitro tests is hindered by the need for larger validation studies and standardized controls.
- Harmonizing diagnostic management globally requires further research and standardization of in vitro testing for DHRs.
Keywords:
Drug hypersensitivityIgET-cellsanaphylaxiscytokinediagnosticin vitro testsp-i conceptproliferationsevere cutaneous reactionsMore Related Videos
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