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Editorial: Advances in hypersensitivity drug reactions.

DOI:10.1097/ACI.0000000000000649 Major topics of this year focus on the allergic reactions in the perioperative period, anaphylactic reactions to biologicals, the role of omalizumab and other humanized anti-IgE antibodies in preventing or attenuating drug reactions, and allergic reactions to vancomycin and corticosteroids. The review of Melchiors and Garvey (pp. 338– 345) deals with perioperative hypersensitivity reactions. Although there is general agreement that these reactions are underreported, continuous efforts between specialists, such as anesthetists and allergists, are improving the approach to how these patients are evaluated. In every person, who experiences an adverse event in the perioperative period, a complete drug allergy assessment should be undertaken. However, there is still a long way to go and in many centres, there are no provisions for such specialist review [1]. Distinguishing allergic from nonallergic sensitivity to the culprit drug is an important objective during allergy evaluation. It is important to provide appropriate recommendations of drugavoidance and drug alternatives [2]. As nonallergic hypersensitivity occurs in the absence of IgE and mechanisms tend to be less severe, it is easier to find alternative drugs and plan future surgical interventions. Antibiotics account for the majority of the reactions, in particular, beta-lactam antibiotics and quinolones [3]. This means that in a postepisode evaluation, individuals must be assessed not only to the anesthetist drugs used but also to antibiotics and NSAIDs if they were used in the perioperative period. Hypersensitivity reactions to beta-lactams are dependent of the side chain structure and cross-reactivity does not extend to monobactams, carbapenems, or higher generation cephalosporins [4]. The diagnosis of quinolone hypersensitivity is mainly based on basophil activation test; skin testing is not useful because of false-positive results [5]. In addition to drug disinfectants, such as chlorhexidine, latex and and radiocontrast media can be the culprit chemicals to trigger the reaction [6]. The time for optimal investigation is more controversial; although it is known that the longer the period to evaluation, the more chance to get a negative result in the case of an IgE mechanism. This does not apply to non-IgE-mediated reactions. A negative skin test can never rule out the risk of a