International Consensus on drug allergy
International Consensus on drug allergy
复制标题
DOI：
10.1111/all.12350
复制
发表时间：
2014-04-01
期刊：
影响因子：
12.4
通讯作者：
Thong, B. Y. -H.
中科院分区：
文献类型：
--
作者：
Demoly, P.;Adkinson, N. F.;Thong, B. Y. -H.
当发生类似过敏的药物反应时，在显示药物特异性抗体或T细胞的证据之前，它们被称为药物超敏反应(DHR)。DHR本质上可以是过敏的或非过敏的，药物过敏是由免疫调节的DHR。这些反应通常是不可预测的。它们可能危及生命，可能需要或延长住院时间，并可能需要在随后的治疗中进行改变。诊断不足(由于报告不足)和过度诊断(由于过度使用“过敏”一词)都很常见。需要对这种反应作出明确诊断，以便制定适当的治疗选择和适当的预防措施。与接受过全面药物过敏检查的患者相比，仅基于DHR病史而不进行进一步测试的错误分类可能会影响治疗选择，导致不良后果，并导致使用更昂贵或更无效的药物。关于一般或特定药物类别引起的DHR的若干指南和/或共识文件可用于支持医疗决策过程。使用标准化的系统方法来诊断和管理人力资源具有改善结果的潜力，因此应加以传播和实施。因此，由欧洲过敏和临床免疫学学会(EAACI)、美国过敏、哮喘和免疫学学会(AAAAI)、美国过敏、哮喘和免疫学学会(ACAAI)和世界过敏组织(WAO)组成的哮喘、过敏和免疫学国际合作(ICAALL)决定发布关于药物过敏的国际共识(ICON)。本文件的目的是强调许多现有指南共有的关键信息，同时批判性地审查和评论证据的任何差异和不足，从而为DHR的诊断和管理提供一份全面的参考文件。
When drug reactions resembling allergy occur, they are called drug hypersensitivity reactions (DHRs) before showing the evidence of either drug-specific antibodies or T cells. DHRs may be allergic or nonallergic in nature, with drug allergies being immunologically mediated DHRs. These reactions are typically unpredictable. They can be life-threatening, may require or prolong hospitalization, and may necessitate changes in subsequent therapy. Both underdiagnosis (due to under-reporting) and overdiagnosis (due to an overuse of the term 'allergy') are common. A definitive diagnosis of such reactions is required in order to institute adequate treatment options and proper preventive measures. Misclassification based solely on the DHR history without further testing may affect treatment options, result in adverse consequences, and lead to the use of more-expensive or less-effective drugs, in contrast to patients who had undergone a complete drug allergy workup. Several guidelines and/or consensus documents on general or specific drug class-induced DHRs are available to support the medical decision process. The use of standardized systematic approaches for the diagnosis and management of DHRs carries the potential to improve outcomes and should thus be disseminated and implemented. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the World Allergy Organization (WAO), has decided to issue an International CONsensus (ICON) on drug allergy. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences and deficiencies of evidence, thus providing a comprehensive reference document for the diagnosis and management of DHRs.