An Updated Review of the Diagnostic Methods in Delayed Drug Hypersensitivity

• Published in: Frontiers in pharmacology Vol. 11; p. 573573
• Main Authors: Copaescu, Ana, Gibson, Andrew, Li, Yueran, Trubiano, Jason A, Phillips, Elizabeth J
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 12-01-2021
• Subjects: delayed hypersensitivity reaction; drug allergy; lymphocyte transformation test (LTT); Review; severe cutaneous adverse reactions; skin testing; T cells; severe cutaneous adverse reactions; drug allergy; delayed hypersensitivity reaction; skin testing; HLA; T cells; lymphocyte transformation test (LTT); enzyme linked ImmunoSpot (ELISpot)
• ISSN: 1663-9812; 1663-9812
• DOI: 10.3389/fphar.2020.573573

Delayed drug hypersensitivity reactions are clinically diverse reactions that vary from isolated benign skin conditions that remit quickly with no or symptomatic treatment, drug discontinuation or even continued drug treatment, to the other extreme of severe cutaneous adverse reactions (SCARs) that are associated with presumed life-long memory T-cell responses, significant acute and long-term morbidity and mortality. Diagnostic "in clinic" approaches to delayed hypersensitivity reactions have included patch testing (PT), delayed intradermal testing (IDT) and drug challenges for milder reactions. Patch and IDT are, in general, performed no sooner than 4-6 weeks after resolution of the acute reaction at the maximum non-irritating concentrations. Functional
and
assays have largely remained the province of research laboratories and include lymphocyte transformation test (LTT) and cytokine release enzyme linked ImmunoSpot (ELISpot) assay, an emerging diagnostic tool which uses cytokine release, typically IFN-γ, after the patient's peripheral blood mononuclear cells are stimulated with the suspected drug(s). Genetic markers such as human leukocyte antigen have shown recent promise for both pre-prescription screening as well as pre-emptive and diagnostic testing strategies.