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Comment & Response
December 18, 2019

Implementation of Genetic Screening to Prevent Severe Cutaneous Adverse Drug Reactions Is Crucial—Rebuttal From the Devil’s Antagonist—Reply

Author Affiliations
  • 1Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2020;156(2):221-222. doi:10.1001/jamadermatol.2019.3335

In Reply I very much thank Chan and Dodiuk-Gad for their comments, as the primary purpose of my editorial1 was to raise awareness of potential controversies regarding HLA screening and to stimulate conversation on this important topic. I agree completely that it is incumbent on us as physicians and researchers specializing in severe cutaneous adverse [drug] reactions (SCAR) to aim to prevent even a single case of Stevens-Johnson syndrome/toxic epidermal necrolysis or other SCAR. It is a lofty goal but a critical one nonetheless. I also concur that there are specific examples in which HLA screening has been successfully implemented, and I hope that this can continue and be expanded on. However, I contend that we should not simply take these few specific examples of success and blindly apply them to every drug/HLA allele association that has been or will be identified in the literature. When considering the question of HLA testing, or any other laboratory test for that matter, I challenge readers to ask themselves these questions: What are the technical limitations of the test? What are the implications of a positive result or a negative result? What is its cost? Are there alternatives? In medicine, there are often gaps between what we should or hope to do and what we actually can do (owing to technical or safety limitations of testing or cost, for example). To the authors’ point, this gap has already narrowed tremendously in SCAR and hopefully will continue to close as technology advances and costs decrease.

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