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Review
. 2014 Aug;34(3):645-62, ix.
doi: 10.1016/j.iac.2014.04.011.

Antiviral drug allergy

Brigitte Milpied-Homsi  1 , Ellen M Moran  2 , Elizabeth J Phillips  3
Affiliations
Review

Antiviral drug allergy

Brigitte Milpied-Homsi et al. Immunol Allergy Clin North Am. 2014 Aug.

Abstract

Antiviral drugs used to treat HIV and hepatitis C are common causes of delayed drug hypersensitivities for which many of the more severe reactions have been recently shown to be immunogenetically mediated such as abacavir hypersensitivity where HLA-B(∗)57:01 is now used routinely as a screening test to exclude patients carrying this allele from abacavir prescription. Most antiviral drug allergies consist of mild to moderate delayed rash without other serious features (eg, fever, mucosal involvement, blistering rash, organ impairment. In these cases treatment can be continued with careful observation and symptomatic management and the discontinuation rate is low.

Keywords: Abacavir; Altered peptide repertoire; Antiretroviral; Human leukocyte antigen; Major histocompatibility complex; Nevirapine; Telaprevir pharmacogenomics.

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Conflict of interest statement

Disclosures/conflict of interest: none related to the content of this article

Figures

Figure 1
Figure 1
ABC patch test: 24-hour reading ABC in concentrations of 0.1, 1, 5, 10, 15, and 25% in petrolatum and petrolatum control are applied to the skin and left undisturbed for 24 hours.
Figure 2
Figure 2
(A) (left) Patient on day 10: abacavir, lamivudine, fosamprenavir and (right) improvement a week later with continued therapy. (B) Patient displays Nevirapine-associated rash at Day 10. (C) Patient with Nevirapine-associated Toxic Epidermal Necrolysis. (D) Patient with Nevirapine-induced DRESS 15 days after the initiation of treatment. (E) Patients displaying Telaprevir-induced rashes of varying severity. Part A shows Grade 1 (mild): treatment is continued. Part B shows Grade 2 (moderate): treatment is continued. Part C shows Grade 3 (severe): treatment is stopped.
Figure 2
Figure 2
(A) (left) Patient on day 10: abacavir, lamivudine, fosamprenavir and (right) improvement a week later with continued therapy. (B) Patient displays Nevirapine-associated rash at Day 10. (C) Patient with Nevirapine-associated Toxic Epidermal Necrolysis. (D) Patient with Nevirapine-induced DRESS 15 days after the initiation of treatment. (E) Patients displaying Telaprevir-induced rashes of varying severity. Part A shows Grade 1 (mild): treatment is continued. Part B shows Grade 2 (moderate): treatment is continued. Part C shows Grade 3 (severe): treatment is stopped.
Figure 2
Figure 2
(A) (left) Patient on day 10: abacavir, lamivudine, fosamprenavir and (right) improvement a week later with continued therapy. (B) Patient displays Nevirapine-associated rash at Day 10. (C) Patient with Nevirapine-associated Toxic Epidermal Necrolysis. (D) Patient with Nevirapine-induced DRESS 15 days after the initiation of treatment. (E) Patients displaying Telaprevir-induced rashes of varying severity. Part A shows Grade 1 (mild): treatment is continued. Part B shows Grade 2 (moderate): treatment is continued. Part C shows Grade 3 (severe): treatment is stopped.
Figure 2
Figure 2
(A) (left) Patient on day 10: abacavir, lamivudine, fosamprenavir and (right) improvement a week later with continued therapy. (B) Patient displays Nevirapine-associated rash at Day 10. (C) Patient with Nevirapine-associated Toxic Epidermal Necrolysis. (D) Patient with Nevirapine-induced DRESS 15 days after the initiation of treatment. (E) Patients displaying Telaprevir-induced rashes of varying severity. Part A shows Grade 1 (mild): treatment is continued. Part B shows Grade 2 (moderate): treatment is continued. Part C shows Grade 3 (severe): treatment is stopped.
Figure 2
Figure 2
(A) (left) Patient on day 10: abacavir, lamivudine, fosamprenavir and (right) improvement a week later with continued therapy. (B) Patient displays Nevirapine-associated rash at Day 10. (C) Patient with Nevirapine-associated Toxic Epidermal Necrolysis. (D) Patient with Nevirapine-induced DRESS 15 days after the initiation of treatment. (E) Patients displaying Telaprevir-induced rashes of varying severity. Part A shows Grade 1 (mild): treatment is continued. Part B shows Grade 2 (moderate): treatment is continued. Part C shows Grade 3 (severe): treatment is stopped.
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References

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