Box 1. Recommendations for diagnosis and management of DHRs in
COVID-19
- No equivalent alternatives for the currently off-label repurposed
drugs or novel drugs used in COVID-19 do exist.
- We should extrapolate our knowledge on DHRs from other clinical
situations to COVID-19 considering the scarse experience for the DHRs
during the disease.
- Various drugs being used in different phases of the disease seem to
cause rare but potentially severe DHRs, mostly non-immediate cutaneous
hypersensitivity reactions based on data from limited number of case
reports.
- The most important differential diagnosis of these DHRs is disease
related exanthems, which can further be classified into the ones
similar to those in other viral infections and the others related to
thrombovascular events and vascular pathologies seen during COVID-19.
- Experience of diagnostic and management methods for DHRs due to the
drugs used in COVID-19 depend mostly on few case reports or series.
- Knowledge of DHRs is urgently needed from pharmacovigilance registries
and data from ongoing clinical trials of COVID-19.
- Quick diagnostic and therapeutic decisions in case of DHRs during
COVID-19 are mandatory.
- Clinical diagnosis of DHRs during COVID-19 might mostly rely on
clinical observations and basic laboratory findings regarding the need
of urgent treatment of COVID-19.
- If the risks of a DHR outweigh the benefits obtained from the drug
administration, the offending drug should be discontinued.
- If an alternative drug cannot be replaced, the offending drug can be
administered via desensitization with published or tailored protocols
when there are no contraindications.
- ‘Treating through’ concept, the continued administration of a drug
despite a suspected allergic hypersensitivity reaction, can also be
considered under strict surveillance measures if the underlying DHR is
mild and self-limiting, and an alternative drug does not exist.