Drug hypersensitivity reactions in Asia: regional issues and challenges

Bernard Yu-Hor Thong; Michaela Lucas; Hye-Ryun Kang; Yoon-Seok Chang; Philip Hei Li; Min Moon Tang; James Yun; Jie Shen Fok; Byung-Keun Kim; Mizuho Nagao; Iris Rengganis; Yi-Giien Tsai; Wen-Hung Chung; Masao Yamaguchi; Ticha Rerkpattanapipat; Wasu Kamchaisatian; Ting Fan Leung; Ho Joo Yoon; Luo Zhang; Amir Hamzah Abdul Latiff; Takao Fujisawa; Francis Thien; Mariana C Castells; Pascal Demoly; Jiu-Yao Wang; Ruby Pawankar

doi:10.5415/apallergy.2020.10.e8

Drug hypersensitivity reactions in Asia: regional issues and challenges

Asia Pac Allergy. 2020 Jan 30;10(1):e8. doi: 10.5415/apallergy.2020.10.e8. eCollection 2020 Jan.

Authors

Bernard Yu-Hor Thong¹, Michaela Lucas², Hye-Ryun Kang³, Yoon-Seok Chang⁴, Philip Hei Li⁵, Min Moon Tang⁶, James Yun⁷, Jie Shen Fok⁸, Byung-Keun Kim⁹, Mizuho Nagao¹⁰, Iris Rengganis¹¹, Yi-Giien Tsai¹², Wen-Hung Chung¹³, Masao Yamaguchi¹⁴, Ticha Rerkpattanapipat¹⁵, Wasu Kamchaisatian¹⁶, Ting Fan Leung¹⁷, Ho Joo Yoon¹⁸, Luo Zhang¹⁹, Amir Hamzah Abdul Latiff²⁰, Takao Fujisawa¹⁰, Francis Thien²¹, Mariana C Castells²², Pascal Demoly²³, Jiu-Yao Wang²⁴, Ruby Pawankar²⁵

Affiliations

¹ Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
² Department of Immunology, Pathwest and Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Perth, Australia.
³ Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Department of Internal Medicine, Seoul National University College of Medicine, Drug Safety Center, Seoul National University Hospital, Seoul, Korea.
⁴ Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
⁵ Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
⁶ Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
⁷ Faculty of Medicine and Health, The University of Sydney, Division of Medicine, Nepean Hospital, Sydney, Australia.
⁸ Department of Respiratory Medicine, Box Hill Hospital, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
⁹ Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea.
¹⁰ Allergy Center of Mie National Hospital, Tsu, Japan.
¹¹ Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
¹² School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹³ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung and Linkou Branches, College of Medicine, Chang Gung University, Taipei, Taiwan.
¹⁴ Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
¹⁵ Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
¹⁶ Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand.
¹⁷ Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong.
¹⁸ Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
¹⁹ Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China..
²⁰ Allergy & Immunology Centre, Pantai Hospital, Kuala Lumpur, Malaysia.
²¹ Eastern Health, Melbourne; Monash University, Melbourne, Australia.
²² Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²³ Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France..
²⁴ Graduate Institute of Medical Sciences, China Medical University, Taichung, Taiwan.
²⁵ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.

Abstract

There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.

Keywords: Anaphylaxis; Asthma; Drugs; Hypersensitivity, Pharmacogenetics.

Publication types

Review