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International Consensus (ICON) on Drug Allergy

Allergy 2014;69: 420–437

Pascal Demoly, N. Franklin Adkinson, Knut Brockow, Mariana Castells, Anca M. Chiriac, Paul A. Greenberger, David A. Khan, David M. Lang, Hae-Sim Park, Werner Pichler, Mario Sanchez-Borges, Tetsuo Shiohara, Bernard Yu-Hor Thong

Drug hypersensitivity reactions (DHRs) are drug reactions resembling allergy. DHRs are frequent (up to 15% of all drug reactions), can be life-threatening and therefore require a definite diagnosis. This generally requires a complete drug allergy work up in an expert centre where based on a thorough clinical history will be decided if additional tests including skin, biochemical and/or drug provocation tests are required. The diagnostic work up will enable to discriminate between a true drug allergy (an immunologically mediated reaction that will occur upon every challenge with a drug, thus prohibiting its further use) and non-allergic DHRs. It will allow the institution of adequate and safe alternative treatment options, often after in-hospital drug provocation testing and provide the patient and health care workers with proper preventive measures. Misclassification based on the DHR history alone may have consequences on individual treatment choices and be more detrimental for the patient than a complete drug allergy work up.
The International Consensus (iCON) on Drug Allegy was carried out by leading allergy organizations worldwide (EAACI, AAAAI, ACAAI and WAO) to synthesize multiple guidelines into one generally approved and accepted consensus document.