Asia Pac Allergy.  2020 Jan;10(1):e8. 10.5415/apallergy.2020.10.e8.

Drug hypersensitivity reactions in Asia: regional issues and challenges

Affiliations
  • 1Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore. bernard_thong@ttsh.com.sg
  • 2Department of Immunology, Pathwest and Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Perth, Australia.
  • 3Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Department of Internal Medicine, Seoul National University College of Medicine, Drug Safety Center, Seoul National University Hospital, Seoul, Korea.
  • 4Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 5Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
  • 6Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
  • 7Faculty of Medicine and Health, The University of Sydney, Division of Medicine, Nepean Hospital, Sydney, Australia.
  • 8Department of Respiratory Medicine, Box Hill Hospital, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
  • 9Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea.
  • 10Allergy Center of Mie National Hospital, Tsu, Japan.
  • 11Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • 12School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
  • 13Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung and Linkou Branches, College of Medicine, Chang Gung University, Taipei, Taiwan.
  • 14Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
  • 15Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
  • 16Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand.
  • 17Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong.
  • 18Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
  • 19Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China..
  • 20Allergy & Immunology Centre, Pantai Hospital, Kuala Lumpur, Malaysia.
  • 21Allergy Center of Mie National Hospital, Tsu, Japan.
  • 22Eastern Health, Melbourne; Monash University, Melbourne, Australia.
  • 23Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • 24Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France.
  • 25Graduate Institute of Medical Sciences, China Medical University, Taichung, Taiwan.
  • 26Department of Pediatrics, Nippon Medical School, Tokyo, Japan.

Abstract

There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.

Keyword

Anaphylaxis; Asthma; Drugs; Hypersensitivity, Pharmacogenetics

MeSH Terms

Adult
Allopurinol
Anaphylaxis
Anti-Bacterial Agents
Asia*
Asian Continental Ancestry Group
Aspirin
Asthma
Carbamazepine
Child
Cicatrix
Contrast Media
Coronary Artery Disease
Diagnostic Tests, Routine
Drug Hypersensitivity*
Ethnic Groups
Humans
Hypersensitivity
Penicillins
Percutaneous Coronary Intervention
Phenotype
Recurrence
Skin Tests
Allopurinol
Anti-Bacterial Agents
Aspirin
Carbamazepine
Contrast Media
Penicillins
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