Nonallergic drug hypersensitivity reactions

Kevin Farnam, Christopher Chang, Suzanne S Teuber, M. Eric Gershwin

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. Methods: We performed a PubMed search using the terms 'drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions' and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. Results: Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current 'gold' standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a 'desensitization' protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. Conclusions: Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.

Original languageEnglish (US)
Pages (from-to)327-345
Number of pages19
JournalInternational Archives of Allergy and Immunology
Volume159
Issue number4
DOIs
StatePublished - Nov 2012

Fingerprint

Drug Hypersensitivity
Immunoglobulin E
Premedication
Non-Steroidal Anti-Inflammatory Agents
Local Anesthetics
Opiate Alkaloids
Hypersensitivity
Pharmaceutical Preparations
Delayed Hypersensitivity
Anaphylaxis
Vancomycin
Routine Diagnostic Tests
PubMed
Gold
Contrast Media
Aspirin
Anesthetics
Publications
Skin

Keywords

  • Anaphylaxis
  • Angioedema
  • Chemotherapy
  • Drug allergy
  • Local anesthetic
  • Nonallergic hypersensitivity
  • Nonsteroidal anti-inflammatory drugs
  • Opiates
  • Pseudoallergy
  • Urticaria

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Nonallergic drug hypersensitivity reactions. / Farnam, Kevin; Chang, Christopher; Teuber, Suzanne S; Gershwin, M. Eric.

In: International Archives of Allergy and Immunology, Vol. 159, No. 4, 11.2012, p. 327-345.

Research output: Contribution to journalArticle

@article{95aa401dfd494ce6af67b2f792e6b678,
title = "Nonallergic drug hypersensitivity reactions",
abstract = "Background: Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. Methods: We performed a PubMed search using the terms 'drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions' and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. Results: Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current 'gold' standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a 'desensitization' protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. Conclusions: Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.",
keywords = "Anaphylaxis, Angioedema, Chemotherapy, Drug allergy, Local anesthetic, Nonallergic hypersensitivity, Nonsteroidal anti-inflammatory drugs, Opiates, Pseudoallergy, Urticaria",
author = "Kevin Farnam and Christopher Chang and Teuber, {Suzanne S} and Gershwin, {M. Eric}",
year = "2012",
month = "11",
doi = "10.1159/000339690",
language = "English (US)",
volume = "159",
pages = "327--345",
journal = "International Archives of Allergy and Immunology",
issn = "1018-2438",
publisher = "S. Karger AG",
number = "4",

}

TY - JOUR

T1 - Nonallergic drug hypersensitivity reactions

AU - Farnam, Kevin

AU - Chang, Christopher

AU - Teuber, Suzanne S

AU - Gershwin, M. Eric

PY - 2012/11

Y1 - 2012/11

N2 - Background: Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. Methods: We performed a PubMed search using the terms 'drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions' and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. Results: Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current 'gold' standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a 'desensitization' protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. Conclusions: Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.

AB - Background: Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. Methods: We performed a PubMed search using the terms 'drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions' and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. Results: Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current 'gold' standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a 'desensitization' protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. Conclusions: Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.

KW - Anaphylaxis

KW - Angioedema

KW - Chemotherapy

KW - Drug allergy

KW - Local anesthetic

KW - Nonallergic hypersensitivity

KW - Nonsteroidal anti-inflammatory drugs

KW - Opiates

KW - Pseudoallergy

KW - Urticaria

UR - http://www.scopus.com/inward/record.url?scp=84864112297&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864112297&partnerID=8YFLogxK

U2 - 10.1159/000339690

DO - 10.1159/000339690

M3 - Article

C2 - 22832422

AN - SCOPUS:84864112297

VL - 159

SP - 327

EP - 345

JO - International Archives of Allergy and Immunology

JF - International Archives of Allergy and Immunology

SN - 1018-2438

IS - 4

ER -