In vitro tests for Drug Hypersensitivity Reactions. An ENDA/EAACI Drug Allergy Interest Group Position Paper

Allergy

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.) 

C Mayorga^1,2, 

G Celik³, 

P Rouzaire⁴, 

P Whitaker⁵, 

P Bonadonna⁶, 

J Rodrigues Cernadas⁷, 

A Vultaggio⁸, 

K Brockow⁹, 

JC Caubet¹⁰, 

J Makowska¹¹, 

A Nakonechna¹², 

A Romano¹³, 

MI Montañez¹⁴, 

JJ Laguna¹⁵, 

G Zanoni¹⁶, 

JL Gueant¹⁷, 

H Oude Elberink¹⁸, 

J Fernandez¹⁹, 

S Viel²⁰, 

P Demoly²¹, 

MJ Torres^2,* and

In vitro tests for Drug Allergy Task Force of EAACI Drug Interest Group

Position Paper

Summary

Drug hypersensitivity reactions (DHR) are a matter of great concern, both for outpatient and in hospital care. The evaluation of these patients is complex, since in vivo tests have suboptimal sensitivity and can be time-consuming, expensive and potentially risky, especially drug provocation tests. There are several currently available in vitro methods that can be classified into two main groups: those that help to characterize the active phase of the reaction and those that help to identify the culprit drug.

The utility of these in vitro methods depends on the mechanisms involved, meaning they cannot be used for the evaluation of all types of DHR. Moreover, their effectiveness has not been defined by consensus agreement between experts in the field.

Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology has organized a task force to provide data and recommendations regarding the available in vitro methods for DHR diagnosis. We have found that although there are many in vitro tests, few of them can be given a recommendation of grade B or above mainly because there is a lack of well-controlled studies most information comes from small studies with few subjects and results are not always confirmed in later studies. Therefore, it is necessary to validate the currently available in vitro tests in large series of well-characterized patients with DHR and to develop new tests for diagnosis.

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