CONCLUSION
This review brings together all the published information about DHRs due
to current and candidate off-label drugs to treat COVID-19. The current
knowledge depends mostly on previous clinical experience and few
published studies or case reports. In near future, we need to obtain
data about DHRs during the disease from ongoing clinical trials and DHR
registries. This review also highlights the presence of two different
groups of disease-related exanthems. We think that it is extremely
important to distinguish these disease-related eruptions from true DHR
related skin manifestations considering that the majority of the drugs
used are more associated with drug-related non-immediate skin reactions.
Hopefully, published literature reveals that most of these drugs rarely
cause DHRs but severe reactions may also occur. Additionaly as time
passes, we will observe if SARS-CoV2 can aggreviate T–cell mediated
reactions as some viruses do (216), and if the hyperinflammation
observed during the course of the disease may influence DHRs.
Considering the severity of the disease and the emergent need for
interventions, it is important to give accurate and quick diagnostic and
therapeutic decisions in case of DHRs. Therefore, the diagnosis can
mostly rely on clinical observations without performing in vivotests which have possible contamination risks, and time consumingin vitro tests. If alternative drugs are not available and
underlying DHR is not severe, we can recommend that drugs can be applied
with published or tailored desensitization protocols (19,20). When mild,
self-limiting DHR is considered, ‘treating through’ concept, the
continued administration of a drug despite a suspected allergic
hypersensitivity reaction, can be considered under strict surveillance
measures (217). Our recommendations for the diagnosis and management of
DHRs due to drugs administered during COVID-19 are listed in Box-1.