International consensus on drug allergy

International consensus on drug allergy

Abstract

When drug reactions resembling allergy occur, they are called drug hypersensitiv-ity reactions (DHRs) before showing the evidence of either drug-specific antibod-ies or T cells. DHRs may be allergic or nonallergic in nature, with drug allergiesbeing immunologically mediated DHRs. These reactions are typically unpredict-able. They can be life-threatening, may require or prolong hospitalization, andmay necessitate changes in subsequent therapy. Both underdiagnosis (due tounder-reporting) and overdiagnosis (due to an overuse of the term ‘allergy’) arecommon. A definitive diagnosis of such reactions is required in order to instituteadequate treatment options and proper preventive measures. Misclassificationbased solely on the DHR history without further testing may affect treatmentoptions, result in adverse consequences, and lead to the use of more-expensive orless-effective drugs, in contrast to patients who had undergone a complete drugallergy workup. Several guidelines and/or consensus documents on general or spe-cific drug class-induced DHRs are available to support the medical decision pro-cess. The use of standardized systematic approaches for the diagnosis andmanagement of DHRs carries the potential to improve outcomes and should thusbe disseminated and implemented. Consequently, the International Collaborationin Asthma, Allergy and Immunology (iCAALL), formed by the European Acade-my of Allergy and Clinical Immunology (EAACI), the American Academy ofAllergy, Asthma and Immunology (AAAAI), the American College of Allergy,Asthma and Immunology (ACAAI), and the World Allergy Organization(WAO), has decided to issue an International CONsensus (ICON) on drugallergy. The purpose of this document is to highlight the key messages that arecommon to many of the existing guidelines, while critically reviewing andcommenting on any differences and deficiencies of evidence, thus providing acomprehensive reference document for the diagnosis and management of DHRs.

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