Controversies in drug allergy: Testing for delayed reactions
Controversies in drug allergy: Testing for delayed reactions
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DOI：
10.1016/j.jaci.2018.10.030
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发表时间：
2019-01-01
影响因子：
14.2
通讯作者：
Barbaud, Annick
中科院分区：
文献类型：
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作者：
Phillips, Elizabeth J.;Bigliardi, Paul;Barbaud, Annick
关于延迟免疫介导的药物不良反应的体内方法存在争议，例如皮疹（斑丘疹）、嗜酸性粒细胞增多和全身症状的药物反应、急性全身发疹性脓疱病、Stevens-Johnson综合征/中毒性表皮坏死松解症和固定性药疹。特别是，在皮内和斑贴测试的可用性和使用、使用的标准药物浓度、在皮内和斑贴测试中使用其他药物来帮助确定交叉反应性、与药物不良反应发生相关的测试时间、在特定表型中使用测试以及使用口服激发与延迟皮内和斑贴测试以确定药物耐受性方面，区域和实践之间存在广泛的差异。值得注意的是，延迟 T 细胞介导的反应科学取得了进展，揭示了免疫发病机制，并为东南亚受试者的 HLA-B*57:01 和阿巴卡韦超敏反应以及 HLA-B*15:02 和卡马西平 Stevens-Johnson 综合征/中毒性表皮坏死松解症提供了处方筛查机制。未来的方向应包括大型国际网络的合作，以开发和标准化体内诊断方法，例如皮肤测试和斑贴测试，并结合离体和体外实验室方法。
Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.