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Making a diagnosis in severe cutaneous drug hypersensitivity reactions

Making a diagnosis in severe cutaneous drug hypersensitivity reactions
Making a diagnosis in severe cutaneous drug hypersensitivity reactions

PURPOSE OF REVIEW: Severe cutaneous adverse reactions (SCAR) are relatively uncommon but can be life-threatening. This review focuses on the nonanaphylactic (non-IgE-mediated) phenotypes of drug hypersensitivity, with specific reference to diagnosis and management of acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). RECENT FINDINGS: Here, we review recent guidelines on optimal supportive care as well as publications of interventional treatment for SJS/TEN, including various immunomodulating therapies, and management strategies for severe ocular disease with the use of amniotic membrane transplantation. In DRESS, long-term autoimmune sequelae are increasingly recognized and modify strategies for treatment of the acute episode. If the causative drug is not apparent from careful inspection of the drug exposure history, in-vitro diagnostics, HLA testing and skin testing before drug challenge testing may be considered and we present an algorithm for investigation of complex cases. SUMMARY: Careful phenotypic analysis of the increasingly complex recognized patterns of SCAR facilitates the enhancement in our understanding of T-cell mediated drug hypersensitivity and allows the improvement of in-vitro diagnostic testing to minimize patient exposure to test substances in all but a very limited number of cases, thereby enhancing safety.

1528-4050
283-293
Ardern-Jones, Michael R.
7ac43c24-94ab-4d19-ba69-afaa546bec90
Mockenhaupt, Maja
6cd81eae-e205-4255-82da-200932c2f23c
Ardern-Jones, Michael R.
7ac43c24-94ab-4d19-ba69-afaa546bec90
Mockenhaupt, Maja
6cd81eae-e205-4255-82da-200932c2f23c

Ardern-Jones, Michael R. and Mockenhaupt, Maja (2019) Making a diagnosis in severe cutaneous drug hypersensitivity reactions. Current Opinion in Allergy and Clinical Immunology, 19 (4), 283-293. (doi:10.1097/ACI.0000000000000546).

Record type: Article

Abstract

PURPOSE OF REVIEW: Severe cutaneous adverse reactions (SCAR) are relatively uncommon but can be life-threatening. This review focuses on the nonanaphylactic (non-IgE-mediated) phenotypes of drug hypersensitivity, with specific reference to diagnosis and management of acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). RECENT FINDINGS: Here, we review recent guidelines on optimal supportive care as well as publications of interventional treatment for SJS/TEN, including various immunomodulating therapies, and management strategies for severe ocular disease with the use of amniotic membrane transplantation. In DRESS, long-term autoimmune sequelae are increasingly recognized and modify strategies for treatment of the acute episode. If the causative drug is not apparent from careful inspection of the drug exposure history, in-vitro diagnostics, HLA testing and skin testing before drug challenge testing may be considered and we present an algorithm for investigation of complex cases. SUMMARY: Careful phenotypic analysis of the increasingly complex recognized patterns of SCAR facilitates the enhancement in our understanding of T-cell mediated drug hypersensitivity and allows the improvement of in-vitro diagnostic testing to minimize patient exposure to test substances in all but a very limited number of cases, thereby enhancing safety.

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CurrOpClinImmunol 2019 Clean submitted revised - Accepted Manuscript
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Published date: 1 August 2019

Identifiers

Local EPrints ID: 435162
URI: http://eprints.soton.ac.uk/id/eprint/435162
ISSN: 1528-4050
PURE UUID: c33cc513-7e9c-4716-b105-be87c0c48118

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Date deposited: 24 Oct 2019 16:30
Last modified: 01 Aug 2020 04:01

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