Table 3 In vitro tests to identify culprit drugs based on underlying immunological mechanism
| Â | Effector cells | Test | Detection | Drug studied | Limitations |
|---|---|---|---|---|---|
Immediate reactions | Mast cells and basophils | Immunoassay | Serum tryptase (normal values: <11.4 ng/mL) | Any drug involved in grade 2–3 anaphylactic reactions | Samples must be obtained within 60–90 min after the reaction |
Specific IgE | β-Lactams, NMBAs, chlorhexidine, and biological agents | Available for few drugs Low sensitivity | |||
Basophil activation test | Activated basophils | β-Lactams, NMBAs, pyrazolones, and fluoroquinolones Potentially available for any injectable drug | Need for fresh blood Low sensitivity | ||
Non-immediate reactions | Cell-mediated: T-cells, NK cells, neutrophils, monocytes | HLA-allele determination | Allele determination | Abacavir, carbamazepine | Associations are very specific for particular drugs and/or types of DHRs Variable sensitivity |
Lymphocyte transformation test | Lymphocyte proliferation | Potentially available for any injectable drug | Limited supportive data Low sensitivity/specificity | ||
ELISpot | Number of cells producing inflammatory markers | Potentially available for any injectable drug | Limited supportive data Low sensitivity/specificity |