Advances in drug allergy, urticaria, angioedema, and anaphylaxis in 2018

• Published in: Journal of allergy and clinical immunology Vol. 144; no. 2; pp. 381 - 392
• Main Authors: Miller, Rachel L., Shtessel, Maria, Robinson, Lacey B., Banerji, Aleena
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2019; Elsevier Limited
• Subjects: Allergies; Anaphylaxis; Anaphylaxis - chemically induced; Anaphylaxis - immunology; Anaphylaxis - therapy; Angioedema; Angioedema - chemically induced; Angioedema - immunology; Angioedema - pathology; Angioedema - therapy; Antibiotic resistance; Antibiotics; beta-Lactams - adverse effects; beta-Lactams - therapeutic use; Clinical trials; Cloning; Dermatitis; Drug allergy; Drug Hypersensitivity - immunology; Drug Hypersensitivity - pathology; Drug Hypersensitivity - therapy; Edema; Epidemiology; Health care expenditures; Hospital costs; Humans; Hypersensitivity (delayed); Hypersensitivity, Delayed - chemically induced; Hypersensitivity, Delayed - immunology; Hypersensitivity, Delayed - pathology; Hypersensitivity, Delayed - therapy; MicroRNAs; Mortality; Pathogenesis; Patients; Pediatrics; Penicillin; Prescription drugs; Pruritus; Quality of Life; Side effects; Staphylococcus infections; Studies; Urticaria; Urticaria - chemically induced; Urticaria - immunology; Urticaria - pathology; Urticaria - therapy; β-Lactam antibiotics; CRP; MPE; CSU; SYK; HSR; UAS; DPT; anaphylaxis; EAI; HAE; EHR; Drug allergy; QOL; angioedema; LOS; CU; BAT; urticaria; CindU; C1-INH; miRNA; TEN; SJS
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2019.06.010

Many notable advances in drug allergy, urticaria, angioedema, and anaphylaxis were reported in 2018. Broad-spectrum antibiotic use and, consequently, antibiotic resistance are widespread, and algorithms to clarify β-lactam allergy and optimize antibiotic use were described. Meaningful data emerged on the pathogenesis of delayed drug hypersensitivity reactions. Progress not only in defining biomarkers but also in understanding the effect on quality of life and developing better treatments has been made for patients with chronic idiopathic urticaria. Patients with hereditary angioedema (HAE) have gained additional access to highly efficacious therapies, with associated improvements in quality of life, and some progress was made in our understanding of recurrent angioedema in patients with normal laboratory results. Guidelines have defined clear goals to help providers optimize therapies in patients with HAE. The epidemiology and triggers of anaphylaxis and the mechanisms underlying anaphylaxis were elucidated further. In summary, these disorders (and labels) cause substantial burdens for individual persons and even society. Fortunately, publications in 2018 have informed on advancements in diagnosis and management and have provided better understanding of mechanisms that potentially could yield new therapies. This progress should lead to better health outcomes and paths forward in patients with drug allergy, urticaria, HAE, and anaphylaxis.