Clinical work-up of adverse drug reactions

Abstract

Self-reported adverse drug reactions (ADRs) are a frequent problem of the daily clinical praxis. Unevaluated ADRs lead to the prescription of less effective or more expensive alternative drugs. Therefore, a work-up is recommended by current European and American guidelines. The work-up begins with a careful case history. Following this, skin tests or, if available, in vitro tests should be performed. If they remain inconclusive, drug provocation tests with the suspicious or alternative drugs should be performed. The results must be given to the patient in a written form, such as by issuing ‘allergy passes’. ADRs are multifactorial diseases and, hence, a lot of medical specialities are involved. Therefore, this interdisciplinary clinical review compiles recent advances in immunological, as well as nonimmunological ADRs (‘hypersensitivity reactions’). First, it begins with an introduction to the definitions (e.g., type B reaction, hypersensitivity reaction, drug allergy). A compilation of new data about the epidemiology of ADRs will be followed by a review on guidelines explaining how these tests shall be performed. This is done with respect to the most relevant classes of drugs causing ADRs, namely antibiotics, nonsteroidal anti-inflammatory drugs, muscle relaxants, local anesthetics and radio contrast media. Current knowledge about the management of acute ADRs will be evaluated. As a future perspective, the possible value of genetic testing prior to prescription for avoiding ADRs will also be discussed.

Keywords::

• adverse drug event
• diagnosis
• drug allergy
• drug hypersensitivity
• drug provocation challenge
• drug provocation test
• drug reaction
• drug re-exposure
• skin test

Notes

Modified from [149].