Drug Hypersensitivity

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art_CASTELLS_Drug_Hypersensitivity_2019.PDF (7.04 MB)
Citações na Scopus
2
Tipo de produção
bookPart
Data de publicação
2019
DOI
Scopus
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ELSEVIER
Autores
CASTELLS, M.
Citação
Castells, M.; Bonamichi-Santos, R.. Drug Hypersensitivity. In: . CLINICAL IMMUNOLOGY: PRINCIPLES AND PRACTICE: ELSEVIER, 2019. p.649-667.e1.
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Resumo
Identifying drug-hypersensitive patients protects them from reexposure to culprit medications and permits access to desensitization procedures when needed and indicated. Identifying patients who are not in fact hypersensitive means they can avoid receiving second-line therapies with their associated increased costs and resource requirements. The vast majority of patients with a history of penicillin allergy have negative results on skin testing and do not react during a challenge or during further courses of penicillin, but there is a lack of standardized reagents approved by the US Food and Drug Administration (FDA) for the diagnosis of allergy to the majority of antibiotics and other drugs. Central to the evaluation of patients with drug hypersensitivity is an understanding of the pathophysiology of the reactions. Genotype studies of patients with severe hypersensitivity reactions, including drug-induced reactions with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrosis (TEN), have uncovered predisposing specific HLA alleles permitting identification of targeted populations and protection against these reactions. Systematic utilization of available markers of immune cell activation, such as tryptase (the major mast cell protease released during anaphylactic IgE- and non-IgE–mediated reactions) can provide useful diagnostic information and help guide the treatment and management of drug reactions.Reactions to drugs are an important source of morbidity and mortality and constitute a major hazard in the practice of medicine. We have an incomplete understanding of the mechanisms of the reactions, few tools for their diagnosis and/or prevention, and limited treatment options. With the introduction of new and better medications to treat cancer, chronic inflammatory diseases, and infections, there has been a parallel increase in the frequency of drug allergy and hypersensitivity. Although these new, targeted therapies offer increased survival and quality of life, repeated exposures to small molecules and monoclonal antibodies (mAbs) with immunogenic and allergenic capacity have increased the rate of sensitizations and reactions. Drug hypersensitivity prevents patients from receiving first-line therapy, and doctors have few guidelines on how to diagnose and address these potentially life-threatening reactions. © 2019 Elsevier Ltd. All rights reserved.
Palavras-chave
Antibiotics, Desensitization, Drug hypersensitivity, Monoclonal antibodies, SJS/TENS, Urticaria
URI
https://observatorio.fm.usp.br/handle/OPI/51196
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Coleções
Livros e Capítulos de Livros - FM/Outros
Livros e Capítulos de Livros - LIM/60
Livros e Capítulos de Livros - ODS/03