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Vol 27. nos. 2&3.
June-September 2022

The general algorithms of laboratory diagnostic of drug hypersensitivity reactions (summary)
Marcelina Niemiec-Urbańczyk, Grażyna Stryjewska-Makuch, Joanna Glück, Karolina Goroszkiewicz
BACKGROUND: Drug hypersensitivity reactions (DHRs) are estimated to account for 3% to 6% of all hospital admissions and to occur in 10% to 15% of hospitalized patients resulting in morbidity, prolonged hospitalization, and increased risk of mortality.

AIM: This review aims: 1) to cast a look on DHRs drug hypersensitivity reactions as allergic and non-allergic; 2) to establish of immunopathogenesis of various DHRs; 3) to create of new laboratory trends for diagnostic of allergic and non-alergic DHRs.

MATERIALS AND METHODS: Clinically patients with DHRs can be classified as a) immediate (urticaria, angioedema, anaphylaxis etc.); b) non-immediate (delayed maculopapular eruptions, SJS/TEN, DRESS, vasculitis and cytopenia). Laboratory diagnostic of DHRs generally starts with in vivo tests (skin prick tests/ skin testing or intradermal testing) and continue with in vitro tests (radio immunoassays, fluor immunoassays, flow cytometry).

RESULT: We propose the new trends to differential diagnostic of DHRs. In vitro testing for immediate IgE-dependent allergies 1) tryptase; 2) histamine release test; 3) specific IgE; 4) cellular in vitro tests - BAT, CAST-ELISA; for drug-specific T cell-mediated reactions 1) classical LTT with detecting of stimulation index; b) modern flow cytometry analysis with measuring the expression of activation surface markers on basophils; 2) ELISpot, which determines the number of cells that release relevant cytokines and cytotoxicity markers; 3) ELISA to measure released cytokines. In vitro testing for non-allergic reactions: 1) biochemical investigation of hepatic and renal metabolism; 2) detecting of the level of arachidonic acid metabolites - leukotrienes, prostaglandins; 3) components of complement C3a, C5a, and C5b-9; bradykinin; factor XII of coagulation system; 4) IgG; 5) infections; 6) active products of nitrosative and oxidative stress etc.

CONCLUSION: We may conclude, that the various endotypes of DHRs identifying characteristics defined by specific mechanisms with each phenotype, diagnostic in vitro algorithm should be based on the new laboratory technologies. The results of various laboratory tests in DHRs- diagnostic will be taken into consideration to assign modern treatment.

Keywords: drug hypersensitivity reactions (DHRs), IgE-dependent DHRs, drug-specific T cell-mediated DHRs, non-allergic drug reactions
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