Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper
Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper
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DOI：
10.1111/all.12142
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发表时间：
2013-06-01
期刊：
影响因子：
12.4
通讯作者：
Terreehorst, I.
中科院分区：
文献类型：
--
作者：
Brockow, K.;Garvey, L. H.;Terreehorst, I.
皮肤试验对药物过敏反应的评价是至关重要的。由于缺乏具体试验浓度的简明信息，通常不进行药物皮肤试验。药物过敏的诊断通常仅基于病史，这是真正过敏的不可靠指标。为了在临床实践中促进和规范安全无刺激性药物浓度的可重复性皮肤试验，欧洲网络和欧洲过敏和临床免疫学学会（EAACI）药物过敏兴趣小组在MEDLINE和EMBASE中进行了关于皮肤试验药物浓度的文献检索，使用GRADE系统对五种语言的文献进行了回顾和评估，以评估证据质量和推荐强度。在文献贫乏的地方，我们考虑了群体的集体经验。我们建议进行药物浓度皮肤试验，目的是达到至少95%的特异性。已经有可能推荐贝他坦类抗生素、围手术期药物、肝素、铂盐和放射线造影剂的特定药物浓度。对于许多其他药物，没有足够的证据来推荐适当的药物浓度。目前迫切需要进行多中心研究，以建立和验证使用标准方案的药物皮试浓度。对于大多数药物，皮肤试验对立即过敏的敏感性高于对非立即过敏的敏感性。
Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.