Multiple Drug Allergy

Multiple Drug Allergy The tendency to develop multiple drug hypersensitivity (MDH), defined as a hypersensitivity to two or more structurally unrelated drugs, occurs in up to 10% of people who have a severe and proven immune-mediated drug hypersensitivity reaction (DHR). There are two subtypes of MDH: in the first type, MDH develops if different drugs are administered simultaneously; in the second, MDH develops if different drugs are administered sequentially, sometimes years apart. MDH presents clinically as immediate and/or non-immediate reactions. The main drugs responsible for MDH are antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), antiepileptics, hypnotics, antidepressants, corticosteroids, and local anesthetics. There are two pathogenic mechanisms of developing MDH: the first is T cell mediated and the second is IgE mediated. Activated T cells are directed against the culprit drug or its metabolites. MDH can be proven by positive responses to patch tests and/or delayed-reading intradermal tests as well as a positive lymphocyte transformation test. During the first DHR, the immune stimulation may lower the threshold of T cell reactivity to that drug and facilitate the immune response to the second drug, similar to viral infections. The drug-reactive T cells in patients with MDH display an enhanced state of activation. Less frequently, the pathogenic mechanism is IgE mediated. This can be proven by positive responses to an immediate-reading intradermal test and provocation test, as well as with positive specific IgE to culprit drug and a basophil activation test (BAT). A T cell-mediated reaction might be built on the IgE-mediated reaction. It is well-known that the tolerance mechanism to small molecular compounds fails in MDH patients, although the pathogenic mechanisms of this syndrome are still unknown. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Treatment Options in Allergy Springer Journals
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Publisher
Springer International Publishing
Copyright
Copyright © 2017 by Springer International Publishing AG
Subject
Medicine & Public Health; Allergology; General Practice / Family Medicine
eISSN
2196-3053
D.O.I.
10.1007/s40521-017-0139-z
Publisher site
See Article on Publisher Site

Abstract

The tendency to develop multiple drug hypersensitivity (MDH), defined as a hypersensitivity to two or more structurally unrelated drugs, occurs in up to 10% of people who have a severe and proven immune-mediated drug hypersensitivity reaction (DHR). There are two subtypes of MDH: in the first type, MDH develops if different drugs are administered simultaneously; in the second, MDH develops if different drugs are administered sequentially, sometimes years apart. MDH presents clinically as immediate and/or non-immediate reactions. The main drugs responsible for MDH are antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), antiepileptics, hypnotics, antidepressants, corticosteroids, and local anesthetics. There are two pathogenic mechanisms of developing MDH: the first is T cell mediated and the second is IgE mediated. Activated T cells are directed against the culprit drug or its metabolites. MDH can be proven by positive responses to patch tests and/or delayed-reading intradermal tests as well as a positive lymphocyte transformation test. During the first DHR, the immune stimulation may lower the threshold of T cell reactivity to that drug and facilitate the immune response to the second drug, similar to viral infections. The drug-reactive T cells in patients with MDH display an enhanced state of activation. Less frequently, the pathogenic mechanism is IgE mediated. This can be proven by positive responses to an immediate-reading intradermal test and provocation test, as well as with positive specific IgE to culprit drug and a basophil activation test (BAT). A T cell-mediated reaction might be built on the IgE-mediated reaction. It is well-known that the tolerance mechanism to small molecular compounds fails in MDH patients, although the pathogenic mechanisms of this syndrome are still unknown.

Journal

Current Treatment Options in AllergySpringer Journals

Published: Jul 20, 2017

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