How to manage drug-virus interplay underlying skin eruptions in children
The majority of viral rashes occurring during an antibiotic therapy are considered as a drug hypersensitivity reaction (DHR). Differentiating a viral rash versus a DHR is difficult or even impossible. In delayed DHRs the interplay between viruses and drugs is summarized according to the recent liter...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | World Allergy Organization Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1939455124000085 |
| _version_ | 1797254011403894784 |
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| author | Francesca Mori, MD, PhD Giulia Liccioli, MD Leonardo Tomei, MD Simona Barni, MD, PhD Mattia Giovannini, MD Lucrezia Sarti, MD Benedetta Pessina, MD María José Torres, MD, PhD |
| author_facet | Francesca Mori, MD, PhD Giulia Liccioli, MD Leonardo Tomei, MD Simona Barni, MD, PhD Mattia Giovannini, MD Lucrezia Sarti, MD Benedetta Pessina, MD María José Torres, MD, PhD |
| author_sort | Francesca Mori, MD, PhD |
| collection | DOAJ |
| description | The majority of viral rashes occurring during an antibiotic therapy are considered as a drug hypersensitivity reaction (DHR). Differentiating a viral rash versus a DHR is difficult or even impossible. In delayed DHRs the interplay between viruses and drugs is summarized according to the recent literature. The question is if the same reaction will again occur in case of drug re-exposure in absence of the concomitant viral infection because of persistent immune reactivity. Epstein Barr Virus (EBV) and Human Herpes virus 6 (HHV-6) models are analyzed in case of maculopapular exanthemas (MPEs) and drug reaction with eosinophilia and systemic symptoms (DRESS) over a course of drug therapy. MPEs are the most common skin manifestation during a viral infection and a concomitant drug therapy. In type IVb reactions to drugs a hapten/pro-hapten mechanism and a pharmacological interaction (p-i mechanism) are described as the 2 major ways to make T cells response functional. Rarely the altered repertoire model is involved. The Human Leukocyte Antigen (HLA) predisposition is an additional essential factor that can facilitate DHR. In MPEs rarely a DHR is confirmed by allergy testing. Severity and duration of MPEs, the presence of eosinophilia and systemic symptoms make more reliable the persistent nature of the reaction. Research on this topic is needed in order to provide the clinicians with instruments to decide when to suspect future reactions upon drug re-exposure even in the absence of a viral infection, because those patients should be investigated by a complete drug allergy work up. |
| first_indexed | 2024-03-08T04:08:07Z |
| format | Article |
| id | doaj.art-f4f73c73015544c79cb94317b5b85bcf |
| institution | Directory Open Access Journal |
| issn | 1939-4551 |
| language | English |
| last_indexed | 2024-04-24T21:43:10Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Allergy Organization Journal |
| spelling | doaj.art-f4f73c73015544c79cb94317b5b85bcf2024-03-21T05:36:13ZengElsevierWorld Allergy Organization Journal1939-45512024-03-01173100877How to manage drug-virus interplay underlying skin eruptions in childrenFrancesca Mori, MD, PhD0Giulia Liccioli, MD1Leonardo Tomei, MD2Simona Barni, MD, PhD3Mattia Giovannini, MD4Lucrezia Sarti, MD5Benedetta Pessina, MD6María José Torres, MD, PhD7Allergy Unit, Meyer Children's Hospital IRCCS, Florence, ItalyAllergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Corresponding author. Allergy Unit, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139, Florence, Italy.Allergy Unit, Meyer Children's Hospital IRCCS, Florence, ItalyAllergy Unit, Meyer Children's Hospital IRCCS, Florence, ItalyAllergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, ItalyAllergy Unit, Meyer Children's Hospital IRCCS, Florence, ItalyAllergy Unit, Meyer Children's Hospital IRCCS, Florence, ItalyAllergy Unit, Hospital Regional Universitario de Málaga-UMA-ARADyAL, Malaga, SpainThe majority of viral rashes occurring during an antibiotic therapy are considered as a drug hypersensitivity reaction (DHR). Differentiating a viral rash versus a DHR is difficult or even impossible. In delayed DHRs the interplay between viruses and drugs is summarized according to the recent literature. The question is if the same reaction will again occur in case of drug re-exposure in absence of the concomitant viral infection because of persistent immune reactivity. Epstein Barr Virus (EBV) and Human Herpes virus 6 (HHV-6) models are analyzed in case of maculopapular exanthemas (MPEs) and drug reaction with eosinophilia and systemic symptoms (DRESS) over a course of drug therapy. MPEs are the most common skin manifestation during a viral infection and a concomitant drug therapy. In type IVb reactions to drugs a hapten/pro-hapten mechanism and a pharmacological interaction (p-i mechanism) are described as the 2 major ways to make T cells response functional. Rarely the altered repertoire model is involved. The Human Leukocyte Antigen (HLA) predisposition is an additional essential factor that can facilitate DHR. In MPEs rarely a DHR is confirmed by allergy testing. Severity and duration of MPEs, the presence of eosinophilia and systemic symptoms make more reliable the persistent nature of the reaction. Research on this topic is needed in order to provide the clinicians with instruments to decide when to suspect future reactions upon drug re-exposure even in the absence of a viral infection, because those patients should be investigated by a complete drug allergy work up.http://www.sciencedirect.com/science/article/pii/S1939455124000085Drug hypersensitivitySkin eruptionViral exanthemaMaculopapular exanthemaChildrenPediatrics |
| spellingShingle | Francesca Mori, MD, PhD Giulia Liccioli, MD Leonardo Tomei, MD Simona Barni, MD, PhD Mattia Giovannini, MD Lucrezia Sarti, MD Benedetta Pessina, MD María José Torres, MD, PhD How to manage drug-virus interplay underlying skin eruptions in children World Allergy Organization Journal Drug hypersensitivity Skin eruption Viral exanthema Maculopapular exanthema Children Pediatrics |
| title | How to manage drug-virus interplay underlying skin eruptions in children |
| title_full | How to manage drug-virus interplay underlying skin eruptions in children |
| title_fullStr | How to manage drug-virus interplay underlying skin eruptions in children |
| title_full_unstemmed | How to manage drug-virus interplay underlying skin eruptions in children |
| title_short | How to manage drug-virus interplay underlying skin eruptions in children |
| title_sort | how to manage drug virus interplay underlying skin eruptions in children |
| topic | Drug hypersensitivity Skin eruption Viral exanthema Maculopapular exanthema Children Pediatrics |
| url | http://www.sciencedirect.com/science/article/pii/S1939455124000085 |
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