New Insights of Biomarkers in IgE and Non-IgE-Mediated Drug Hypersensitivity

AbstractBackground Drug hypersensitivity reactions (DHRs) occurring less than 6  h after the drug intake are named immediate reactions. They include allergic reactions, and pseudo-allergic or non-allergic reactions, and despite their similar clinical manifestations, the underlying mechanism is different. Its identification is essential for their management. In IgE-mediated-DHR s, the best biomarker is drug-specific IgE, which can be determined by in vivo and in vitro tests. Identifying the culprit drug is critical for the design of avoidance strategies and the recommendation of safe alternatives for future treatments.Recent findings It has been suggested the existence of other mechanisms beyond IgE and related with the drug interaction with MRGPRX2 or IgG receptors, or mediated by their effect on some enzymes. However, the lack of a clear biomarker for characterizing them, together with the difficulty of predicting cross-reactivity, makes the management of non-allergic reactions very complex.Desensitization is standard intervention in allergic patients who need the drug. It is successful in IgE-mediated DHRs but its value on non-IgE-mediated DHRs is not well-known.Summary Further research is needed to identify the mechanism involved in DHRs considering that IgE and non-allergic reactions cannot be mutually exclusive and can happen simultaneously, increasing their severity. It is crucial the identification of biomarkers in non-allergic reactions.
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research