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Cellular in vitro diagnosis of adverse drug reactions

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Abstract

Adverse drug reactions can manifest clinically in a variety of ways. Whilst the majority can be explained by dose-dependent side effects, there is group of unpredictable immunological or non-immunological intolerances that represent a particular diagnostic challenge. Skin tests are frequently negative, whilst challenge tests are time-consuming and often hazardous. Against this backdrop, cellular in vitro tests play a particularly important role in the identification of the causative drug. Whilst basophil tests can be used in the case of immunoglobulin E (IgE)- as well as non-IgE-mediated hypersensitivity reactions, T-cellular test methods assist in the diagnosis of drug eruptions. The reliability of individual tests can be affected by a variety of parameters, such as the pathomechanism underlying the drug reaction, the causative medication, or the point in time of testing. Not only is a sound knowledge of the basic principles of the individual assays an essential prerequisite for correctly indicating and interpreting this test method, but also an awareness of these additional factors.

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Abbreviations

ADR:

Adverse drug reactions

AGEP:

Acute generalized exanthematous pustulosis

APC:

Antigen-presenting cells

BAT:

Basophil activation test

CAST:

Cellular activated antigen stimulation test

DRESS:

Drug rash with eosinophilia and systemic symptoms

ELISA:

Enzyme-linked immunosorbent assay

ELISPOT:

Enzyme-linked immunospot

HRT:

Histamine release test

IFN:

Interferon

IgE:

Immunoglobulin E

IL:

InterleukinE

LTT:

Lymphocyte transformation test

mDrug:

Metabolized drug

NSAR:

Non-steroidal antirheumatic drug

PEN:

Penicillin

RIA:

Radio immunoassay

SI:

Stimulation index

TEN:

Toxic epidermal necrolysis

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Authors and Affiliations

  1. Department of Dermatology and Allergology, Allergy Center Hessen, Philipps University Marburg, Marburg, Germany

    Christian Möbs &  Wolfgang Pfützner

  2. Clinical & Experimental Allergy, Allergy Center Hessen, Department of Dermatology and Allergology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany

    Wolfgang Pfützner

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  1. Christian Möbs
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  2. Wolfgang Pfützner
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Correspondence to Wolfgang Pfützner.

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Conflict of interest

Dr. Christian Möbs states that there are no conflict of interest. Prof. Dr. Wolfgang Pfützner states the following: Cooperation in studies which are financed by Allergopharma and Astellas, consultant and lectures for ALKAbelló and Novartis and research funding from Biomay.

Cite this as Möbs C, Pfützner W. Cellular in vitro diagnosis of adverse drug reactions. Allergo J Int 2014;23:164–71 DOI 10.1007/s40629-014-0020-6

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Möbs, C., Pfützner, W. Cellular in vitro diagnosis of adverse drug reactions. Allergo J Int 23, 164–171 (2014). https://doi.org/10.1007/s40629-014-0020-6

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