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Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries

Tang MM 1 , Fok JS 2 , Thong BY 3 , Yun J 4 , Li PH 5 , Kang HR 6 Show all authors , Thien F 7 , Yamaguchi M 8 , Lucas M 9 , Chang YS 10 , Kim BK 11 , Nagao M 12 , Rengganis I 13 , Tsai YG 14 , Chung WH 15 , Rerkpattanapipat T 16 , Kamchaisatian W 17 , Leung TF 18 , Ho JY 19 , Zhang L 20 , Latiff AHA 21 , Fujisawa T 12 , Castells MC 22 , Demoly P 23 , Wang JY 24 , Pawankar R 25

Affiliations 

  • 1 Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 2 Department of Respiratory Medicine, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
  • 3 Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
  • 4 Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Division of Medicine, Nepean Hospital, Sydney, Australia
  • 5 Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
  • 6 Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Drug Safety Center, Seoul National University Hospital, Seoul, Korea
  • 7 Eastern Health, Melbourne; Monash University, Melbourne, Australia
  • 8 Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
  • 9 Department of Immunology, Pathwest and Sir Charles Gairdner Hospital, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
  • 10 Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 11 Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
  • 12 Allergy Center of Mie National Hospital, Tsu, Japan
  • 13 Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 14 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 15 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
  • 16 Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 17 Pediatric Allergy and Immunology Division, Samitivej Children's Hospital, Bangkok, Thailand
  • 18 Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
  • 19 Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
  • 20 Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
  • 21 Allergy & Immunology Centre, Pantai Hospital, Kuala Lumpur, Malaysia
  • 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, France; UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France
  • 24 Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
  • 25 Department of Pediatrics, Nippon Medical School, Tokyo, Japan
Asia Pac Allergy, 2020 Oct;10(4):e36.
PMID: 33178561 DOI: 10.5415/apallergy.2020.10.e36

Abstract

Background: The issues and challenges in the diagnosis of drug allergy/hypersensitivity among children and adults in Asia are likely to be different from non-Asian countries.

Objective: To study the diagnostic modalities used in the evaluation and management of drug allergy/drug hypersensitivity reactions (DHRs) among member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI).

Methods: A questionnaire comprising 41 questions was circulated electronically to member societies and individual members of APAAACI between January 23, 2020 and March 6, 2020.

Results: Twenty-six respondents from 15 member societies and 1 individual member responded. European DHR guidelines were most commonly used. Skin prick and intradermal testing was used by 100%, with only 60% having access to commercial penicillin skin test reagents. In vitro-specific IgE tests were used by 75%, and basophil activation test by 56.3% for immediate DHR. Patch tests were used by 75% in contrast to lymphocyte transformation tests by 25% for nonimmediate DHR. Drug provocation tests were used by 68.8%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (93.3%). Human leukocyte antigen (HLA) genotype testing was mandatory among 25% respondents before new carbamazepine prescriptions, and 8.3% for allopurinol prescriptions.

Conclusions: There was increased use of skin testing for iodinated contrast media hypersensitivity and patch testing for nonimmediate DHR. HLA genotype testing prior to new carbamazepine, allopurinol and abacavir prescriptions remain variable despite strong associations for severe cutaneous adverse reactions with Asian ethnicity. Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across APAAACI member societies.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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