The clinical presentations of delayed drug hypersensitivity are various. They range from mild reactions (e.g., maculopapular exanthema (MPE) and fixed drug eruption (FDE)) to drug-induced liver injury (DILI) and severe cutaneous adverse reactions (SCARs) (e.g., Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS)). The common culprits of delayed drug hypersensitivity include anti-epileptics, antibiotics, anti-gout agents, anti-viral drugs, etc. Delayed drug hypersensitivity is proposed to be initiated by different models of molecular recognition, composed of drug/metabolite antigen and endogenous peptide, HLA presentation, and T cell receptor (TCR) interaction. Increasing genetic variants of HLA loci and drug metabolic enzymes have been identified as responsible for delayed drug hypersensitivity. The genetic susceptibility of delayed drug hypersensitivity showed drug-specific, phenotype-specific, and ethnic variation.
| Causative Drugs | Reactions | Genetic Factors | Ethnicity | OR (95% CI) |
p-Value | Reference | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Amoxicillin | MPE | HLA-DRB3*02:02 | European | 8.88 (3.37–23.32) 1 | <0.0001 | [72][37] | |||||||||
| [ | 63 | ] | [28] | ||||||||||||
| Co-amoxiclav | DILI | HLA-DRB1*15:01 | European | 2.59 (1.44–4.68) | 0.002 | [73 | 7.27 (2.04–25.97) | 4.46 × 10−13 | [43][8] | ||||||
| ] | [ | 38 | ] | Japanese | 62.8 (21.2–185.8) | 5.388 × 10−12 | [67][32] | ||||||||
| Flucloxacillin | DILI | HLA-B*57:01 | European | 80.6 (22.8–284.9) | 8.97 × 10−19 | [74][39] | Indian | 71.40 (3.0–1698) | 0.0014 | ||||||
| Sulfamethoxazole (SMX) | SJS/TEN | HLA-B*38 | [42][7] | ||||||||||||
| Malaysian | |||||||||||||||
| Thai | 348.3 (19.2–6336.9) | 1.6 × 10−13 | [65][30] | European | 8.6 (3.5–21) | <0.003 | [63][28] | 16.15 (4.57–62.4) | 7.87 × 10−6 | [41][6] | |||||
| 579.0 (29.5–11,362.7) | <0.001 | [ | |||||||||||||
| Co-trimoxazole (SMX/TMP) | SJS/TEN | 66][31] | HLA-B*15:02 | Thai | 3.91 (1.42–10.92) | 0.0037 | [75][40] | Vietnamese | 33.78 (7.55–151.03) | <0.0001 | [39][4] | ||||
| DRESS | HLA-B*58:01 | Han Chinese | 47.7 (18.2–125.4) | 1.0 × 10−26 | [71][36] | ||||||||||
| HLA-C*06:02 | 11.84 (1.24–566.04) | 0.0131 | Singaporean | 27.20 (2.67–∞) | 0.004 | [38][3] | |||||||||
| Thai | 430.3 (22.6–8958.9) | <0.001 | [66][ | ||||||||||||
| HLA-C*08:01 | 31 | ] | 3.53 (1.21–10.40) | 0.0108 | HLA-B*57:01 | European | 9.0 (4.2–19.4) | 9.62 × 10−7 | [45] | ||||||
| SCARs | [ | 10 | ] | ||||||||||||
| SCARs | HLA-B*58:01 | Korean | 97.8 (18.3–521.5) | 2.45 × 10−11 | [ | HLA-A*11:01-B*15:02 haplotype,68 | Thai (HIV-infected patients only) | 4.36 (1.43–13.34) | 0.0108][33] | [77][42] | DRESS | HLA-A*31:01 | Han Chinese | 23.0 (4.2–125) | <0.001 |
| HLA-B*58:01 | Han Chinese | 44.0 (21.5–90.3) | 2.6 × 10 | ||||||||||||
| HLA-B*13:01-C*03:04 haplotype | 3.77 (1.27–11.19) | −41 | 0.0251 | [71][ | |||||||||||
| HLA-B*13:01 | Han Chinese, Thai, Malaysia | 11.7 (5.7–24) | 1.3 × 10−13 | [76][41] | |||||||||||
| Vancomycin | DRESS | HLA-A*32:01 | European | NA | 1 × 10−8 | [84][49] | |||||||||
| Dapsone | SCARs | HLA-B*13:01 | Thai | 39.00 (7.67–198.21) | 5.34 × 10−7 | [85][50] | |||||||||
| 54.00 (7.96–366.16) | 0.0001 | [88][53] | |||||||||||||
| DRESS | HLA-B*13:01 | Han Chinese | 20.53 (11.55–36.48) | 6.84 × 10−25 | [86][51] | ||||||||||
| Taiwanese, Malaysian | 49.64 (5.89–418.13) | 2.92 × 10−4 | [87][52] | ||||||||||||
| HLA-B*13:01 | Korean | 73.67 (2.56–2119.93) | 0.012 | [89][54] | |||||||||||
| HLA-B*13:01 | Papua | 233.46 (1.7–67.7) | 7.11 × 10−9 | [90][55] |
| Causative Drugs | Reactions | Genetic Factors | Ethnicity | OR (95% CI) |
p-Value | Reference |
|---|---|---|---|---|---|---|
| Abacavir | DiHS | HLA-B*57:01 | Caucasians | 23.6 (8.0–70.0) | <0.0001 | [92][57] |
| 117 (29–481) | <0.0001 | [93][58] | ||||
| NA | NA | [94][59] | ||||
| Nevirapine | SJS/TEN | rs3099844 (HCP5) | Mozambique | 2.03 (na) | 0.039 | [102][67] |
| HLA-C*04:01 | African | 4.84 (2.71–8.61) | 8.47 × 10−8 | [97][62] | ||
| DiHS | HLA-Cw*04 | Thai | 2.43(1.22–4.84) | 0.17 | [96][61] | |
| NA | 0.0088 | [104][69] | ||||
| Asians, Blacks, Whites | 2.51 (1.73–3.62) | 8.7 × 10−6 | [96][61] | |||
| Han Chinese | 3.611 (1.135–11.489) | 0.030 | [101][66] | 36] | [47][12] | |
| HLA-B*35:05 | Thai | 18.96 (4.87–73.44) | 4.6 × 10−6 | [95][60] | ||
| HLA-B*35 | Asians | 3.47 (1.58–7.61) | 0.053 | [96][61] | ||
| HLA-DRB1*01 | Whites | 3.02 (1.66–5.49) | 0.0074 | [96][61] | ||
| 4.8 (na) | 0.14 | [98][63] | ||||
| HLA-Cw*08 | Sardinian | NA | 0.05 | [99][64] | ||
| Japanese | NA | 0.03 | [100][65] | |||
| Raltegravir | DRESS | HLA-B*53:01 | African | NA | NA | [103][68] |
| Causative Drugs | Reactions | Genetic Factors | Ethnicity | OR//break//(95% CI) | p-Value | Reference | |||
|---|---|---|---|---|---|---|---|---|---|
| Methimazole | DIA | HLA-DRB1*08:03:02 | Japanese | 5.42 (na) | 0.002 | [105][70] | |||
| HLA-B*38:02, DRB1*08:03 haplotype | Han Chinese | 48.41 (21.66–108.22) | 3.32 × 10−21 | [107][72] | |||||
| HLA-B*38:02 | 21.48 (11.13–41.48) | 6.75 × 10−32 | |||||||
| HLA-DRB1*08:03 | 6.13 (3.28–11.46) | 1.83 × 10−9 | |||||||
| Carbimazole/Methimazole | DIA | HLA-B*38:02:01 | Han Chinese | 265.5 (27.87–2528.0) | 2.5 × 10−14 | [108][73] | |||
| Carbimazole, Methimazole, Propylthiouracil | DIA | HLA-B*27:05 | Caucasian | 7.30 (3.81–13.96) | 1.91 × 10−9 | [109][74] | |||
| Methimazole, Propylthiouracil | DIA | HLA-B*27:05 | Han Chinese | 60.11 (3.27–1104.4) | 1.1 × 10−4 | [110][75] | |||
| HLA-B*38:02 | 6.55 (2.11–20.36) | 2.41 × 10−4 | |||||||
| HLA-DRB1*08:03 | 3.95 (1.60–9.79) | 6.86 (2.4–19.9) | 2.7 × 10−3 | [50][15 | |||||
| 1.57 × 10 | −3 | European] | |||||||
| 39.11 (4.49–340.51) | 5.9 × 10 | −4 | [64][29] | ||||||
| Methazolamide | SJS/TEN | HLA-B*59:01 | Han Chinese | 305.0 (11.3–8259.9) | 6.3 × 10−7 | [111][76] | European | 49.9 (12.9–193.6) | 4.0 × 10 |
| Korean | −8 | 249.8 (13.4–4813.5) | [45][10] | ||||||
| <0.001 | [ | 112 | ][77] | 13.2 (8.4–20.8) | <0.001 | [47][12] | |||
| Japanese | NA | NA | [114][79] | 12.41 (1.27–121.03) | 3.5 × 10 | ||||
| HLA-B*59:01 | −8 | Han Chinese | [48][13] | ||||||
| 146.00 (16.12–1321.98) | 6.19 × 10 | −10 | [ | 113][78] | 22.00 (1.03–1190.36) | 0.047 | [49][14] | ||
| Japanese | 10.8 (5.9–19.6) | 3.64 × 10−15 | |||||||
| 20.86 (9.03–48.20) | |||||||||
| 1.22 × 10 | |||||||||
| −13 | |||||||||
| DILI | HLA-B*58:01, HLA-B*53:01 cluster | African-American, Caucasian, Hispanic | NA | 0.0007 | [69][34] | ||||
| MPE | HLA-B*58:01 | Thai | 144.0 (13.9–1497.0) | <0.001 | [66][31] | [ | |||
| Han Chinese | 8.5 (4.2–17.5) | 2.3 × 10−9 | [51][16] | ||||||
| HLA-B*55:02 | MPE/DRESS | HLA-A*31:01 | Han Chinese | 17.5 (4.6–66.5) | 0.0022 | [46][11] | |||
| [ | MPE | HLA-B*15:02 | Thai | 7.27 (2.04–25.97) | 0.0022 | [43][8] | |||
| 71 | ] | [ | Oxcarbazepine (OXC) | SJS/TEN | HLA-B*15:02 | Han Chinese | 27.90 (7.84–99.23) | 1.12 × 10−9 | [52][17] |
| 71.00 (7.84–643.10) | 1.43 × 10 | −4 | 80.7 (3.8–1714.4) | 8.4 × 10−4 | [53][18] | ||||
| MPE | HLA-A*32:01 | Han Chinese | 15.877 (1.817–138.720) | 0.004 | [57][22] | ||||
| Phenytoin (PHT) | SCARs | CYP2C9*3 | Taiwanese | 14.00 (6.75–29.02) | 0.00001 | [58][23] | |||
| Japanese | 8.88 (2.20–35.83) | ||||||||
| Malaysian | 5.60 (0.56–56.20) | ||||||||
| Thai | 4.30 (1.41–13.09) | <0.05 | [59][24] | ||||||
| 60 | ] | [ | 25] | ||||||
| 36 | ] | Taiwanese, Japanese, Thai | HLA-B*15:02 | Asian (Han Chinese, Japanese, Malaysian) | 5.0 (2.0–13) | 0.025 | [58][23] | ||
| SJS/TEN | HLA-B*15:02 | Han Chinese | 5.1 (1.8–15.1) | 0.0041 | [53][18] | ||||
| 3.50 (1.10–11.18) | 0.045 | [55][20] | |||||||
| Thai | 18.5 (1.82–188.40) | 0.005 | [40][5] | ||||||
| Malaysian | 5.71 (1.41–23.10) | 0.016 | [54][19] | ||||||
| Lamotrigine (LTG) | SCARs | HLA-A*31:01 | Korean | 11.43 (1.95–59.77) | 0.0037 | [61][26] | |||
| HLA-B*38:01 | European | 147.00 (1.88–483) | 0.001 | [49][14] | |||||
| SJS/TEN | HLA-B*15:02 | Han Chinese | 4.98 (1.43–17.28) | 0.01 | [56][21] | ||||
| AEDs (CBZ, LTG, PHT, etc.) | SCARs | HLA-B*15:02 | Han Chinese | 17.6 (2.9–105.2) | 0.001 | [37][2] |
| Reactions | Genetic Factors | Ethnicity | OR (95% CI) |
p-Value | Reference |
|---|---|---|---|---|---|
| SJS/TEN | HLA-B*58:01 | Han Chinese | 580.3 (34.4–9780.9) | 4.7 × 10−24 | [62][27 |