Severe Delayed Drug Reactions: Role of Genetics and Viral Infections

Abstract

Adverse drug reactions (ADRs) are a significant source of patient morbidity and mortality and represent a major burden to health care systems and drug development. Up to 50% of such reactions are preventable. Although many ADRs can be predicted based on the on-target pharmacologic activity, ADRs arising from drug interactions with off-target receptors are recognized. Off-target ADRs include the immune-mediated ADRs (IM-ADRs) and pharmacologic drug effects. In this review, we discuss what is known about the immunogenetics and pathogenesis of IM-ADRs and the hypothesized role of heterologous immunity in the development of IM-ADRs.

Keywords: Adverse drug reaction; Drug reaction with eosinophilia and systemic symptoms; Human herpes virus; Human leukocyte antigen; Pharmacogenomics; Steven Johnson syndrome; T-cell receptor; Toxic epidermal necrolysis.