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Review
. 2017 Jun 7;18(6):1222.
doi: 10.3390/ijms18061222.

The Value of In Vitro Tests to DiminishDrug Challenges

Cristobalina Mayorga  1   2 , Inmaculada Doña  3 , Ezequiel Perez-Inestrosa  4   5 , Tahia D Fernández  6 , Maria J Torres  7   8
Affiliations
Review

The Value of In Vitro Tests to DiminishDrug Challenges

Cristobalina Mayorga et al. Int J Mol Sci. .

Abstract

Drug hypersensitivity reactions have multiple implications for patient safety and health system costs, thus it is important to perform an accurate diagnosis. The diagnostic procedure includes a detailed clinical history, often unreliable; followed by skin tests, sometimes with low sensitivity or unavailable; and drug provocation testing, which is not risk-free for the patient, especially in severe reactions. In vitro tests could help to identify correctly the responsible agent, thus improving the diagnosis of these reactions, helping the physician to find safe alternatives, and reducing the need to perform drug provocation testing. However, it is necessary to confirm the sensitivity, specificity, negative and positive predictive values for these in vitro tests to enable their implementation in clinical practice. In this review, we have analyzed these parameters from different studies that have used in vitro test for evaluating drug hypersensitivity reactions and estimated the added value of these tests to the in vivo diagnosis.

Keywords: IgE; T-cells; allergy; basophils; cytokines; diagnosis; drug; hypersensitivity; immunoassays; in vitro.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Bars represent the global sensitivity (mean plus standard deviation) for in vivo and in vitro tests alone or in combination for the evaluation of immediate drug hypersensitivity reactions (IDHR). BAT: Basophil activation test.
Figure 2
Figure 2
(a) Bars represent the sensitivity of immunoassays (white bars), basophil activation test (BAT) (light grey bars) and immunoassay + BAT (dark grey bars) in individual studies performed with patients with IDHR to BLs, FQs or NMBAs; and (b) Bars represent the sensitivity of in vitro tests (including immunoassay and BAT) (white bars), in vivo tests (light grey bars) and combination of the results of both in vitro and in vivo tests (dark grey bars) in individual studies performed with patients with IDHR to different drug groups. BLs: β-lactams; FQ: Fluoroquinolones; NMBAs: Neuromuscular blocking agents; and RCM: Radio contrast media.
Figure 3
Figure 3
Bars represent the global sensitivity of different in vivo and in vitro tests (mean plus standard deviation), either alone or in combination, for the evaluation of non-immediate drug hypersensitivity reactions (NIDHR).
Figure 4
Figure 4
Bars represent the sensitivity of in vitro tests (white bars), in vivo tests (light grey bars) and combination of the results of both in vitro and in vivo tests (dark grey bars) in individual studies performed with NIDHR patients.
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