Severe adverse drug reactions (ADRs) include Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome (DiHS)/drug response with eosinophilia and systemic symptoms (DRESS). There is an urgent need for laboratory tests that are accurate, noninvasive, and standardised for identifying individuals at high risk of developing severe ADRs. Although earlier research has shown that TNF-, IFN-, IL-10, perforin/granzyme B, Fas L, and granulysin play a pathogenic role in the development of severe ADRs, no biomarkers have been identified that indicate progression to severe ADRs. As a result, researchers examined blood levels of cytokines/chemokines as well as other biological markers in patients who initially presented with clinical symptoms indicative of ADRs. The findings demonstrate that sFas L is a valuable early biomarker that can predict the progression to TEN but not SJS, especially when coupled with an increase in IL-6 and IP-10. Increased IL-6 and IP-10 levels are valid indicators for the progression of severe ADRs such as SJS/TEN and DiHS/DRESS.
Although not sufficiently sensitive or specific on its own, the use of a combination of multiple early biomarkers might improve diagnostic and prognostic value for the prediction of severe ADRs.