Belgian Journal of Paediatrics
Drug hypersensitivity reactions: an overview
Vol. 25 No. 4 (2023), Theme issue articles
Vol. 25 No. 4 (2023)

Drug hypersensitivity reactions: an overview

Theme issue articles
Published 2024-01-18
Athina L van Gasse
Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence and Department of Paediatrics, University of Antwerp and Antwerp University Hospital, Antwerp (Belgium)
Marie-Line M van der Poorten
Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence and Department of Paediatrics, University of Antwerp and Antwerp University Hospital, Antwerp (Belgium)
Margo M Hagendorens
Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence and Department of Paediatrics, University of Antwerp and Antwerp University Hospital, Antwerp (Belgium)
Vito Sabato
Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp (Belgium) and AZ Jan Palfijn Gent, Department of Immunology and Allergology, Ghent (Belgium)
Didier G Ebo
Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp (Belgium) and AZ Jan Palfijn Gent, Department of Immunology and Allergology, Ghent (Belgium)
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Keywords

drug hypersensitivity
hypersensitivity
immunoglobulin E
T-lymphocytes
penicillins
diagnostic errors

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How to Cite

van Gasse, A. L., van der Poorten, M.-L. M., Hagendorens, M. M., Sabato, V., & Ebo, D. G. (2024). Drug hypersensitivity reactions: an overview. Belgian Journal of Paediatrics, 25(4), 260–264. Retrieved from https://belgjpaediatrics.com/index.php/bjp/article/view/229
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Abstract

Drug hypersensitivity reactions (DHRs) account for 10% of all adverse drug reactions.

DHRs are clinically classified as immediate, mostly drug-specific IgE antibody (sIgE) -mediated, and nonimmediate, mostly T-cell mediated, reactions. Gathering insights into the underlying pathophysiological mechanism is crucial for correct orientation of further diagnostic work-up of DHRs. Therefore, a thorough history focusing on elements such as signs, symptoms, timing, index drug, re-exposition is of paramount importance.  In case of immediate DHR, diagnosis may comprise skin testing with immediate readings, sIgE antibody quantification, specialized in vitro diagnostics. In nonimmediate DHR, sIgE antibodies are not useful and skin tests are performed with delayed readings. In difficult cases with negative or uncertain test results, eventually a drug challenge might be required to document or refute diagnosis. 

Correct diagnosis of DHRs is very important. Unverified and false diagnoses of “drug allergy”, mainly “penicillin allergy”, have evolved into a plague with increasing medical and financial burden. On the other hand, misdiagnosis entails a risk for potentially life-threatening and fatal reactions upon re-exposure. Therefore, quick referral for an allergy workup in case of a possible DHR is recommended.

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