Publication: Prevention of Drug Hypersensitivity Reactions: Prescreening and Premedication
6
Issued Date
2021-08-01
Resource Type
ISSN
22132198
Other identifier(s)
2-s2.0-85111206632
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Allergy and Clinical Immunology: In Practice. Vol.9, No.8 (2021), 2958-2966
Suggested Citation
Bernard Yu-Hor Thong, Alessandra Vultaggio, Ticha Rerkpattanapipat, Rik Schrijvers Prevention of Drug Hypersensitivity Reactions: Prescreening and Premedication. Journal of Allergy and Clinical Immunology: In Practice. Vol.9, No.8 (2021), 2958-2966. doi:10.1016/j.jaip.2021.04.006 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/77999
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Title
Prevention of Drug Hypersensitivity Reactions: Prescreening and Premedication
Abstract
Drug hypersensitivity reactions (DHR) are heterogeneous in their pathomechanisms, clinical presentation, severity, and outcomes. Novel DHR mechanisms, phenotypes, and endotypes have been described. The key to prevention from further exposure to the culprit drugs involves correct identification of the putative drug through a combination of in vitro and/or in vivo tests, accurate drug allergy labeling and reporting, and electronic decision support systems within electronic medical records to prevent future accidental prescribing. Prescreening and premedication, the focus of this review, may be a useful adjunct to preventive measures in certain situations. After an index immediate drug hypersensitivity reaction, prescreening may be useful in perioperative anaphylaxis, and iodinated (ICM) and gadolinium-based contrast media (GCM) where the culprit and potential alternative agents are skin tested. In certain nonimmediate DHR, pharmacogenomic prescreening may be used before prescribing high-risk drugs (eg, carbamazepine and allopurinol) where specific human-leukocyte antigen genotypes are associated with severe cutaneous adverse reactions. Premedication with antihistamine and systemic corticosteroids is another therapeutic strategy to prevent infusion reactions for certain biologicals and chemotherapeutic agents, in cases of perioperative anaphylaxis, ICM and GCM DHR, and clonal mast cell disorders. Rapid drug desensitization may also be used to induce temporary tolerance in situations where there are limited alternative drugs.