Diagnosing and managing patients with drug hypersensitivity

Drug hypersensitivity reactions: review of the state of the science for prediction and diagnosis

Drug hypersensitivity reactions (DHRs) are a type of adverse drug reaction that can occur with different classes of drugs and affect multiple organ systems and patient populations. DHRs can be classified as allergic or non-allergic based on the cellular mechanisms involved. Whereas nonallergic reactions rely mainly on the innate immune system, allergic reactions involve the generation of an adaptive immune response. Consequently, drug allergies are DHRs for which an immunological mechanism, with antibody and/or T cell, is demonstrated. Despite decades of research, methods to predict the potential for a new chemical entity to cause DHRs or to correctly attribute DHRs to a specific mechanism and a specific molecule are not well-established. This review will focus on allergic reactions induced by systemically administered low-molecular weight drugs with an emphasis on drug- and patient-specific factors that could influence the development of DHRs. Strategies for predicting and diagnosing DHRs, including potential tools based on the current state of the science, will also be discussed.

Hypersensitivity reaction to certolizumab pegol in a patient affected by psoriatic arthritis

The pathogenic mechanism of hypersensitivity reactions (HSRs) to monoclonal antibodies is not fully understood. HSRs can occur after the first exposure or multiple exposures and include acute infusion reactions induced by cytokine release, besides Type I, Type III, and Type IV reactions.). We reported a case of anaphylactic reaction to certolizumab pegol in a patient affected by psoriatic arthritis and a possible management of this condition.