In vitro diagnosis of delayed-type drug hypersensitivity: Mechanistic aspects and unmet needs

摘要

Challenges in in vitro immediate drug hypersensitivity reaction (DHR) diagnosis lie in the development and validation of reliable assays enabling safe and correct identification of all incriminated agents and potential alternatives for the future. Although drug provocation tests (DPT) are considered as the gold standard for drug hypersensitivity diagnosis, DPT are hampered by the risk of severe, life-threatening reactions and might be contraindicated (ie, patients taking (3-blockers or angiotensin-converting enzyme inhibitors) or not possible for obvious reasons (ie, hypersensitivity to neuro-muscular blocking agents [NMBA]). Besides, even DPT do not show absolute predictive values.1 Hitherto, diagnostic DPT have not entered mainstream clinical practice. Therefore, diagnosis of immediate DHR usually starts with a thorough history complemented with skin tests or in vitro quantification of (commercially available) specific IgE (slgE) antibodies when an IgE-mediated mechanism with activation of mast cells and basophils is suspected.