title: Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America.
abstract: Drug hypersensitivity reactions (DHRs) affect an unknown proportion of the general population, and are an important public health problem due to their potential to cause life-threatening anaphylaxis and rare severe cutaneous allergic reactions. DHR evaluations are frequently needed in both ambulatory and hospital settings and have a complex diagnosis that requires a detailed clinical history and other tests that may include in vitro tests and in vivo procedures such as skin tests and drug provocation tests. Although over the years both European and U.S. experts have published statements on general procedures for evaluating DHRs, a substantial discordance in their daily management exists. In this review, we highlight both the differences and the similarities between the European and U.S.
  
  
  CONCLUSIONS
  While a general consensus exists on the importance of skin tests for evaluating DHRs, concordance between Americans and Europeans exists solely regarding their use in immediate reactions and the fact that a confirmation of a presumptive diagnosis by drug provocation tests is often the only reliable way to establish a diagnosis. Finally, great heterogeneity exists in the application of in vitro tests, which require further study to be well validated.
authors.affiliation: Allergy Unit, National Network ARADyAL, IBIMA-Regional University Hospital of Malaga-UMA (Pavilion C), Plaza del Hospital Civil, 29009 Malaga, Spain.|BIONAND-Andalusian Centre for Nanomedicine and Biotechnology, Malaga, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
authors.affiliation: Allergy Unit, Presidio Columbus, Rome, Italy.|IRCCS Oasi Maria S.S., Troina, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.affiliation: Department of Chest Diseases, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Celik
authors.affiliation: Hôpital Arnaud de Villeneuve, University Hospital of Montpellier and Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Demoly
authors.affiliation: Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Khan
authors.affiliation: Kaiser Permanente Health Care Program, San Diego, CA USA.
authors.forename: E
authors.initials: E
authors.lastname: Macy
authors.affiliation: Mayo Clinic College of Medicine, Division of Allergic Diseases, Mayo Clinic, Rochester, MN 55905 USA.
authors.forename: M
authors.initials: M
authors.lastname: Park
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA.
authors.forename: K
authors.initials: K
authors.lastname: Blumenthal
authors.affiliation: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Aberer
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MSA USA.
authors.forename: M
authors.initials: M
authors.lastname: Castells
authors.affiliation: Sorbonne Universities, UPMC Univ Paris 06, Dermatology and Allergology Department, Tenon Hospital (AP-HP), 4 rue de la chine, 75020 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Barbaud
authors.affiliation: Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA (Pavilion C), Plaza del Hospital Civil, 29009 Malaga, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Mayorga
authors.affiliation: Allergy Unit, Azienda Ospedaliera Universitaria Intergrata of Verona, Verona, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bonadonna
keywords: Allergy; Diagnosis; Drug; Drug provocation test; Europe; Hypersensitivity; IgE; In vitro test; Sensitization; Skin test; T-cells; United States