Drug allergy
Drug allergy
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DOI：
10.1016/j.jaci.2005.11.002
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发表时间：
2006-02-01
影响因子：
14.2
通讯作者：
Greenberger, PA
中科院分区：
文献类型：
--
作者：
Greenberger, PA
药物反应可分为可预测和不可预测两种。可预见的反应是药物药理作用的结果。不可预测的反应可能是特异性的，可能是药物不耐受，也可能有或暗示有免疫基础，如IgE介导。非IgE介导的直接反应可视为假过敏（非IgE介导的肥大细胞活化）。本文将讨论免疫调节剂、青霉素和头孢菌素、磺胺类药物、阿司匹林和非选择性非甾体类抗炎药的过敏和免疫反应，并考虑史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解（TEN）等严重的药物相关疾病。药物“过敏”领域已经扩展到包括与免疫抑制药物、抗细胞因子疗法和单克隆抗体相关的不良反应。白细胞计数大于50 × 10(9)/L的白血病患者输注抗cd20抗体时发生的细胞因子释放反应与高浓度的TNF、IL-6和IL-8有关。由于出现发热、呼吸困难、僵硬和低血压，这种反应类似于继发梅毒患者在给予青霉素60至90分钟后发生的Jarisch-Herxheimer反应。此外，青霉素过敏患者的护理在缺乏主要决定因素青霉聚赖氨酸的情况下变得更加困难，因为对青霉素皮肤试验反应阳性的患者中有34%至84%对主要决定因素有阳性反应。SJS和TEN通常是在开始治疗的1至8周内由药物引起的。角质形成细胞死亡的证据是：(1)穿孔蛋白颗粒酶b介导的药物特异性细胞毒性和(2)角质形成细胞上Fas的激活，这些证据为皮肤脱落提供了解释。不幸的是，静脉注射免疫球蛋白治疗SJS和TEN的效果令人失望。
Drug reactions can be considered as being either predictable or unpredictable. A predictable reaction would be the result of the pharmacologic action of the medication. An unpredictable reaction might be idiosyncratic, might be drug intolerance, or might have or imply an immunologic basis, such as being IgE mediated. Immediate reactions that are not IgE mediated can be considered as pseudoallergic (non-IgE-mediated mast cell activation). This review will discuss allergic and immunologic reactions to immunomodulators, penicillins and cephalosporins, sulfonamides, aspirin, and nonselective nonsteroidal anti-inflammatory drugs and consider the serious drug-related conditions of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The field of drug "allergy" has expanded to include adverse reactions associated with immunosuppressive medications, anticytokine therapies, and mAbs. The cytokine release reaction that occurs with anti-CD20 antibody infusions in patients with leukemia and white blood cell counts of greater than 50 x 10(9)/L is associated with high concentrations of TNF, IL-6, and IL-8. Because of the findings of fever, dyspnea, rigors, and hypotension, this reaction resembles the Jarisch-Herxheimer reaction that occurs 60 to 90 minutes after penicillin administration in patients with secondary syphilis. Furthermore, the care of the patient with penicillin allergy has been made more difficult in the absence of the major determinant, penicilloyi-polylysine, in that from 34% to 84% of patients who have positive skin test reactions to penicillin have exclusively positive reactions to the major determinant. SJS and TEN typically are caused by medications within I to 8 weeks of initiation of therapy. Evidence for death of the keratinocytes through (1) drug-specific cytotoxicity with the perforin-granzyme B-mediated killing and (2) activation of Fas on keratinocytes have provided explanations for the sloughing of skin. Unfortunately, intravenous immunoglobulin therapy for SJS and TEN has been disappointing.