Update in drug allergy: novel drugs with novel reaction patterns

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In the last years, many novel drugs have been introduced, generating new patterns of drug hypersensitivity. There are also novel clinical and biologic techniques that have enabled us to understand the mechanisms and diagnosis of reactions to old used drugs. This review summarizes current knowledge on the epidemiology, mechanisms, and clinical and in-vitro diagnosis of these reactions. Traditional and complementary alternate medicines are also causes of adverse drug reactions, and many of them are cataloged as allergy. Research in the field of skin and drug provocation test to antibiotics such as beta-lactams and carbapenems, and iodinated and gadolinium contrast media has allowed the understanding of cross-reactivity reactions and permitted the use of well tolerated alternate drugs in cases of proper negative drug allergy work-up. Many unique cases have been reported, including diverse drugs as infliximab, succinylcholine, hydroxychloroquine, that widen the spectrum of clinical manifestations of drug hypersensitivity to various drugs. Several studies have been published in the field of in-vitro diagnosis, including basophil activation tests, radioallergosorbent test, Immuno-Cap, ELISA, enzyme-linked immunospot assays, and T-cell proliferation tests allowing novel approaches to assess drug allergy. As new and old drugs continue to be used, new reports regarding new and known drug hypersensitivity manifestations are made. Advances in mechanisms are enhanced by the use of new in-vitro techniques to detect specific antibodies or T cells. Research in the field of skin and provocation tests has allowed the use of well tolerated alternate drugs in individuals with proven drug allergy.