Katherine C Konvinse1, Elizabeth J Phillips, Katie D White, Jason A Trubiano. 1. aDepartment of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA bInstitute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia cDepartment of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA dDepartment of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA eDepartment of Infectious Diseases, Austin Hospital, Victoria, Australia fDepartment of Infectious Diseases, Alfred Hospital, Victoria, Australia gDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia hDepartment of Medicine, University of Melbourne, Victoria, Australia.
Abstract
PURPOSE OF REVIEW: Antimicrobials are a leading cause of severe T cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in-vitro, in-vivo, and ex-vivo diagnostics for T cell-mediated ADRs. RECENT FINDINGS: Recent literature has evaluated the efficacy of traditional antibiotic allergy management, including patch testing, skin prick testing, intradermal testing, and oral challenge. Although patch and intradermal testing are specific for the diagnosis of immune-mediated ADRs, they suffer from drug-specific limitations in sensitivity. The use of ex-vivo diagnostics, especially enzyme-linked immunospot, has been highlighted as a promising new approach to assigning causality. Knowledge of true rates of antimicrobial cross-reactivity aids empirical antibiotic choice in the setting of previous immune-mediated ADRs. SUMMARY: In an era of increasing antimicrobial resistance and use of broad-spectrum antimicrobial therapy, ensuring patients are assigned the correct 'allergy label' is essential. Re-exposure to implicated antimicrobials, especially in the setting of severe adverse cutaneous reaction, is associated with significant morbidity and mortality. The process through which an antibiotic label gets assigned, acted on and maintained is still imprecise. Predicting T cell-mediated ADRs via personalized approaches, including human leukocyte antigen-typing, may pave future pathways to safer antimicrobial prescribing guidelines.
PURPOSE OF REVIEW: Antimicrobials are a leading cause of severe T cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in-vitro, in-vivo, and ex-vivo diagnostics for T cell-mediated ADRs. RECENT FINDINGS: Recent literature has evaluated the efficacy of traditional antibiotic allergy management, including patch testing, skin prick testing, intradermal testing, and oral challenge. Although patch and intradermal testing are specific for the diagnosis of immune-mediated ADRs, they suffer from drug-specific limitations in sensitivity. The use of ex-vivo diagnostics, especially enzyme-linked immunospot, has been highlighted as a promising new approach to assigning causality. Knowledge of true rates of antimicrobial cross-reactivity aids empirical antibiotic choice in the setting of previous immune-mediated ADRs. SUMMARY: In an era of increasing antimicrobial resistance and use of broad-spectrum antimicrobial therapy, ensuring patients are assigned the correct 'allergy label' is essential. Re-exposure to implicated antimicrobials, especially in the setting of severe adverse cutaneous reaction, is associated with significant morbidity and mortality. The process through which an antibiotic label gets assigned, acted on and maintained is still imprecise. Predicting T cell-mediated ADRs via personalized approaches, including human leukocyte antigen-typing, may pave future pathways to safer antimicrobial prescribing guidelines.
Authors: Seth Hetherington; Arlene R Hughes; Michael Mosteller; Denise Shortino; Katherine L Baker; William Spreen; Eric Lai; Kirstie Davies; Abigail Handley; David J Dow; Mary E Fling; Michael Stocum; Clive Bowman; Linda M Thurmond; Allen D Roses Journal: Lancet Date: 2002-03-30 Impact factor: 79.321
Authors: Zaal Meher-Homji; Constantine S Tam; Jim Siderov; John Francis Seymour; Natasha E Holmes; Kyra Y L Chua; Elizabeth J Phillips; Monica A Slavin; Jason A Trubiano Journal: Leuk Lymphoma Date: 2019-07-01
Authors: Jason A Trubiano; Kaija Strautins; Alec J Redwood; Rebecca Pavlos; Katherine C Konvinse; Ar Kar Aung; Monica A Slavin; Karin A Thursky; M Lindsay Grayson; Elizabeth J Phillips Journal: J Allergy Clin Immunol Pract Date: 2017-10-31
Authors: Fiona James; Michelle S Y Goh; Effie Mouhtouris; Sara Vogrin; Kyra Y L Chua; Natasha E Holmes; Andrew Awad; Ana-Maria Copaescu; Joseph F De Luca; Celia Zubrinich; Douglas Gin; Heather Cleland; Abby Douglas; Johannes S Kern; Constance H Katelaris; Francis Thien; Sara Barnes; James Yun; Winnie Tong; William B Smith; Andrew Carr; Tara Anderson; Amy Legg; Jack Bourke; Laura K Mackay; Ar Kar Aung; Elizabeth J Phillips; Jason Trubiano Journal: BMJ Open Date: 2022-08-17 Impact factor: 3.006