oa Current Allergy & Clinical Immunology - Immune-mediated adverse drug reactions in South Africa : review article

Volume 28, Issue 3
  • ISSN : 1609-3607



In South Africa, adverse drug reactions have recently been implicated in 16% of deaths in medical wards. Immune-mediated hypersensitivity reactions (HSR) account for only a small fraction of this mortality. Immune-mediated reactions, however, are idiosyncratic, often with a rapid onset of life- threatening clinical features; this makes them feared by clinician and patient alike. The diverse clinical spectrum of HSR means that it presents across clinical disciplines, often with ultimate consultation to allergists, pharmacologists and dermatologists for a definite diagnosis and plan for future management. The imperfect understanding of reactive drug immunogens and immunopathogenesis, together with the lack of robust and diagnostic tools, makes confident diagnosis and management challenging in many instances. This is especially true for uncommon Type 1 and the Type IV HSR occurring in the context of HIV-related immune dysregulation and polypharmacy (especially with TB co-infection). In this review we aim to contextualise immune-mediated drug hypersensitivity reactions within the epidemiology of ADRs in South Africa. Current conceptual models of immune activation by drugs, and the clinical spectrum of reactions are discussed. Finally, the diagnostic armamentarium and roles of allergist, pharmacologist and dermatologist in the management of these complex patients, stressing the need for multidisciplinary clinics to provide optimum care and improve research in local priority areas, are highlighted.

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