ADRs can also be explained on the basis of drug hypersensitivity or drug allergy reactions.

The term
“drug hypersensitivity” refers to reproducible symptoms and signs initiated by exposure to drug at a
normal dose. While “drug allergy” refers to immunologically mediated drug hypersensitive reactions
defined by the British Society for Allergy and Clinical Immunology (BSACI) (9). Risk factors for drug
allergy includes nature of the drug, degree of exposure, age, genetic factors, previous drug reactions,
and multiple allergy syndrome etc (10). Drug allergy may lead to serious events in ADR’s which has the
potential to constitute high level of morbidity and mortality. So it is necessary to detect the
immunological mechanisms by the identification involving in laboratory tests, patient family and clinical
history and detailed evaluation for the better treatment of patients (5). Different type of studies showed
that the diagnosis of a pharmacovigilance algorithms in patients having histories of hypersensitivity
reactions is not accurate and cannot replace drug allergy testing (1). Therefore a database collection is
required for drug allergy and hypersensitivity using standard operating systems (SOPs), for its diagnosis
which is standardized by the Europeon Network for drug allergy (ENDA) and Europeon academy of
allergology and clinical immunology. Confirmation of the diagnosis should be based on clinical history
and physical examination, possibly followed by skin and drug provocation tests. This platform along with
the pharmacovigilance network appears to be of great interest for the allergic ADRs in conjugation with
other pharmacovigilance instruments (2). One study is conducted in Beijing china on the basis of
pharmacovigilance database to identify the cause of drug-induced anaphylaxis (DIA) and different case
reports are taken by the Beijing centre for ADR monitoring. Some reports in Chinese patients provides
important information to clinicians that the drugs involving Antibiotics, TCM, radiocontrast media along
with antineoplastic drugs are the most common reasons of DIA cases. The majority of DIA cases have the
high mortality rate. So it was concluded that Pharmacists should work with physicians closely to
measure each patient’s risks of developing anaphylaxis when drug therapy is involved, and to give
prompt treatment to reduce the morbidity and mortality in such cases (8). Another retrospective study
was conducted where DIA over a decade was reported to the Portuguese Pharmacovigilance Authority
to analyze and detect the severity of ADRs. This study demonstrated that the ADR is a problem in all age
groups where the most affecting patients are female. Here the cases are classified with respect to WHO
system according to the standardize causality assessment (4). In the retrospective study of central
Portugal, it was demonstrated using a Standardized MedDRA Query (SMQ) that drugs causing
hypersensitivity include antibiotics, anti-inflammatory drugs, along with some antineoplastic agents (6).
Another prospective data was obtained which was held in hospitalized patients which confirmed that
immunological events mostly occurs because of immunoglobulin E-mediated immediate hypersensitivity
or due to T-cell-mediated delayed hypersensitivity using a network-based electronic system (7). So it is
concluded from different study analysis that by the identification of risk factors, appropriate genetic
screening and by the collaboration of physicians, immunologists, clinicians and pharmacist, all these
interventions will contribute a better treatment methodologies and we can get success in health
outcomes on drug allergies (3).

References:

1. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486646
2. https://pubmed.ncbi.nlm.nih.gov/19178398/
3. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2125.2010.03774.x
4. https://link.springer.com/article/10.1007/s00228-012-1376-5
5. https://pubmed.ncbi.nlm.nih.gov/15309226/
6. https://www.tandfonline.com/doi/abs/10.1080/14740338.2020.1743262
7. https://www.sciencedirect.com/science/article/abs/pii/S1081120610618042
8. https://link.springer.com/article/10.1007/s11096-017-0535-2
9. https://www.nice.org.uk/guidance/cg183/chapter/introduction
10. https://www.karger.com/Article/FullText/507445