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Table 3 In vitro tests to identify culprit drugs based on underlying immunological mechanism

From: Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America

  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
  1. NMBAs neuromuscular blocking agents, DHRs drug hypersensitivity reactions, ELISpot enzyme-linked immunosorbent spot