Asia Pac Allergy.  2019 Jul;9(3):e20. 10.5415/apallergy.2019.9.e20.

Human leukocyte antigen-associated severe cutaneous adverse drug reactions: from bedside to bench and beyond

Affiliations
  • 1Division of Respiratory, Allergy and Clinical Immunology, Vinmec International Hospital, Times City and VinUni Project, Hanoi, Vietnam. v.dinhnv6@vinmec.com
  • 2Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
  • 3Department of Allergy and Clinical Immunology, Hanoi Medical University, Hanoi, Vietnam.
  • 4Centre of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi, Vietnam.
  • 5Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.

Abstract

Despite their being uncommon, severe cutaneous adverse drug reactions (SCARs) result in a very great burden of disease. These reactions not only carry with them a high mortality (10%-50%) and high morbidity (60%) with severe ocular complications, alopecia, oral and dental complications and development of autoimmune diseases, but also create a substantial economic burden for patients' families and society. SCARs are, therefore, an important medical problem needing a solution in many countries, especially in Asia. The clinical spectrum of SCARs comprises Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS (drug rash with eosinophilia and systemic symptoms) (also known as drug hypersensitivity syndrome or drug-induced hypersensitivity syndrome) and acute generalised exanthematous pustulosis. Recent crucial advances in determining genetic susceptibility and understanding how T cells recognise certain medications or their metabolites via the major histocompatibility complex and the effects of cofactors, have led to the implementation of cost-effective screening programs enabling prevention in a number of countries, and to further understanding of the patho-mechanisms involved in SCARs and their significance. In this review, we document comprehensively the journey of SCARs from bedside to bench and outline future perspectives in SCARs research.

Keyword

Severe cutaneous adverse drug reactions; Human leukocyte antigen; T-cell-mediated reactions

MeSH Terms

Alopecia
Asia
Autoimmune Diseases
Cicatrix
Drug Hypersensitivity Syndrome
Drug-Related Side Effects and Adverse Reactions*
Eosinophilia
Exanthema
Genetic Predisposition to Disease
Humans*
Hypersensitivity
Leukocytes*
Major Histocompatibility Complex
Mass Screening
Mortality
Stevens-Johnson Syndrome
T-Lymphocytes
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