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.