Nomenclature on Immune‐Mediated Drug Reactions: An EAACI Position Paper
Year: 2026
Type: article
Abstract: Over the past several decades, there have been significant advances in our understanding of both immunological and pharmacological mechanisms of adverse drug reactions (ADRs). Immune-mediated drug reactions (IMDRs) represent a small proportion of ADRs and are caused by a pathological activation of the immune system or inflammatory pathways. Drugs can act as an antigen or may directly interact with the immune system or inflammatory pathways, making immune-mediated drug reactions observed in contemporary practice not sufficiently explained by the Gell and Coombs (G&C) framework. Moreover, the phenotype alone is neither pathognomonic nor sufficient to infer the endotype. The proposed nomenclature integrates chrono-morphological phenotypes, mechanistic endotypes and characteristics of the involved drug. In this nomenclature, IMDRs are classified, according to the nature of interaction with the immune system, in: (i) drug allergy that encompasses antigen-driven reactions-diagnosed by tests detecting sensitisation-and (ii) drug hypersensitivity that includes the heterogeneous broad group of drug-directly-driven reactions. This framework supports precision medicine, aligns terminology with mechanisms, and provides a common language for interdisciplinary communication, pharmacovigilance, and drug development. It accommodates emerging therapeutic classes and remains adaptable to future discoveries in immunopathogenesis and biomarker development.
Source: Allergy
DOI: 10.1111/all.70480
Authors: Maria J. Torres, Cristobalina Mayorga, Elizabeth J. Phillips, Adriana Ariza, Annick Barbaud, Patrizia Bonadonna, Mariana Castells, Gülfem Çelik, Knut Brockow, Lene H. Garvey, Inmaculada Doña, Jean‐Christoph Caubet, Francesca Mori, Jason Trubiano, Giorgia Marta, Antonino Romano, Ingrid Terreehorst, Asli Gelincik, Philip H. Li, Vito Sabato
Institutions: Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Vanderbilt University Medical Center, Inserm, Sorbonne Université, Institut Pierre Louis d‘Épidémiologie et de Santé Publique, Hôpital Tenon, Azienda Ospedaliera Universitaria Integrata Verona, Brigham and Women's Hospital, Harvard University, Ankara University, Technical University of Munich, University of Copenhagen, Herlev Hospital, Gentofte Hospital, University of Geneva, University Hospital of Geneva, Meyer Children's Hospital, Austin Health, Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers, Istanbul University, University of Hong Kong, University of Antwerp, Antwerp University Hospital
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,300
Award: G2754571612
OpenAlex ID: W7203650128