Drug Hypersensitivity Diagnosis and Management
Summary
Drug hypersensitivity encompasses a spectrum of immune-mediated adverse reactions to medications, ranging from mild cutaneous eruptions to life-threatening anaphylaxis. Accurate diagnosis relies on a detailed clinical history, in vivo and in vitro testing, and, when indicated, controlled drug challenges. Management strategies include avoidance of the culprit agent, selection of safe alternatives, and, for patients requiring first-line therapies to which they are allergic, desensitisation protocols to induce temporary drug tolerance. Recent advances have refined risk assessment tools, harmonised diagnostic algorithms across regions, and expanded our understanding of the molecular mechanisms that underpin IgE- and non-IgE-mediated reactions. These developments have global significance for antimicrobial stewardship, chemotherapy delivery and broader efforts to de-label inaccurate allergy records, reducing reliance on second-line therapies and improving patient outcomes.
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Drug Hypersensitivity Diagnosis and Management publication trend
The graph below shows the total number of articles in drug hypersensitivity diagnosis and management across all publications each year (not limited to Nature Index journals).
Technical terms
Drug de-labelling: The process of removing a recorded drug allergy label after accurate risk assessment.
Skin testing: An in vivo procedure applying small drug amounts to the skin to detect immediate hypersensitivity.
Drug provocation test: Controlled administration of incremental doses of a suspected drug to confirm or exclude hypersensitivity.
Desensitisation: Incremental reintroduction of an allergenic drug to induce a transient tolerant state.
Immunoglobulin E (IgE)-mediated hypersensitivity: An immediate allergic reaction driven by IgE antibodies that trigger mast cell degranulation.
References
- Narrative review of recent developments and the future of penicillin allergy de-labelling by non-allergists. npj Antimicrobials and Resistance (2024).
- Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches. International Journal of Molecular Sciences (2017).
- Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America. Clinical and Translational Allergy (2017).
- Hypersensitivity Reactions to Platinum Agents and Taxanes. Clinical Reviews in Allergy & Immunology (2021).
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