Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis

Frontiers in Immunology

Jose Julio Laguna¹  Esther Barrionuevo²  Maria José Torres²  Gador Bogas²  Cristobalina Mayorga²  Inmaculada Doña²  Maria Isabel Montañez³  Angela Martin-Serrano³  Ruben Fernandez-Santamaria⁴  Tahia Diana Fernandez⁴ 

[1] Allergy Unit, Cruz Roja Hospital, Madrid, Spain;Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain;Andalusian Center for Nanomedicine and Biotechnology—BIONAND, Málaga, Spain;Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain;

关键词: anaphylaxis;    drugs;    IgE;    MAS-related G protein-coupled receptor;    IgG;    in vivo diagnosis;   

DOI  :  10.3389/fimmu.2017.00614

来源: DOAJ

【 摘 要 】

Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators by mast cells and basophils. Although anaphylaxis is often under-communicated and thus underestimated, its incidence appears to have risen over recent decades. Drugs are among the most common triggers in adults, being analgesics and antibiotics the most common causal agents. Anaphylaxis can be caused by immunologic or non-immunologic mechanisms. Immunologic anaphylaxis can be mediated by IgE-dependent or -independent pathways. The former involves activation of Th2 cells and the cross-linking of two or more specific IgE (sIgE) antibodies on the surface of mast cells or basophils. The IgE-independent mechanism can be mediated by IgG, involving the release of platelet-activating factor, and/or complement activation. Non-immunological anaphylaxis can occur through the direct stimulation of mast cell degranulation by some drugs, inducing histamine release and leading to anaphylactic symptoms. Work-up of a suspected drug-induced anaphylaxis should include clinical history; however, this can be unreliable, and skin tests should also be used if available and validated. Drug provocation testing is not recommended due to the risk of inducing a harmful reaction. In vitro testing can help to confirm anaphylaxis by analyzing the release of mediators such as tryptase or histamine by mast cells. When immunologic mechanisms are suspected, serum-sIgE quantification or the use of the basophil activation test can help confirm the culprit drug. In this review, we will discuss multiple aspects of drug-induced anaphylaxis, including epidemiology, mechanisms, and diagnosis.

【 授权许可】

Unknown