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Identifying the Culprit Drug in Severe Cutaneous Adverse Reactions (SCARs)

  • Drug Allergy (C Mayorga, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Abstract

Purpose of review

Identifying the culprit drug or drugs in SCARs (Severe Cutaneous Adverse Reactions) is a complex and challenging task. However, it is necessary for the patient to know which drugs to avoid in the future, alternatives for treatment and not to have forbidden for all his life drugs that were not responsible for the reaction. When to use causality algorithms? To which extent are valid in vitro tests? Are they useful in clinical practice or just research techniques? Are skin tests sensitive and safe in all SCARs? When performing them? What about the re-exposure tests? Is there any indication for them? This review gives answers to these questions.

Recent findings

Causality algorithms and the calculation of the index day is the first approach. In vitro tests, LTT (lymphocyte transformation test) is a sensitive and specific test for SJS/TEN (Stevens-Johnson syndrome/toxic epidermal necrolysis) and DRESS (drug reaction with eosinophilia and systemic symptoms) in the recovery phase. ELISpot is useful during the acute phase. Skin tests have different sensitivity according to every particular SCAR and are safe if performing according to guidelines recommendations.

Summary

An approach combining causality algorithms, LTT, and skin tests allow us to identify the culprit drugs or at least limiting the forbidden drugs for the future in a safe way.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Allergy Unit, Hospital Universitario La Paz, Madrid, Spain

    Rosario Cabañas

  2. La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain

    Rosario Cabañas, Elena Ramírez & Teresa Bellón

  3. PIELenRed Consortium, Madrid, Spain

    Rosario Cabañas, Elena Ramírez & Teresa Bellón

  4. Centro de Investigación en Red de Enfermedades Raras (CIBERER, U754), Madrid, Spain

    Rosario Cabañas

  5. Pharmacology Department, La Paz University Hospital, Madrid, Spain

    Elena Ramírez

  6. Drug Hypersensitivity Laboratory, La Paz University Hospital, Madrid, Spain

    Teresa Bellón

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  1. Rosario Cabañas
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Cabañas, R., Ramírez, E. & Bellón, T. Identifying the Culprit Drug in Severe Cutaneous Adverse Reactions (SCARs). Curr Treat Options Allergy 8, 194–209 (2021). https://doi.org/10.1007/s40521-021-00291-1

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