Controversies in drug allergy: Testing for delayed reactions

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:143

Article

Phillips, Elizabeth J.^1,2  Bigliardi, Paul³  Bircher, Andreas J.⁴  Broyles, Ana^5,6  Chang, Yoon-Seok⁷  Chung, Wen-Hung^8,9,10  Lehloenya, Rannakoe^11,12  Mockenhaupt, Maja^13,14  Peter, Jonny^11,12  Pirmohamed, Munir¹⁵  Roujeau, Jean-Claude¹⁶  Shear, Neil H.¹⁷  Tanno, Luciana Kase^18,19,20  Trubiano, Jason^21,22,23  Valluzzi, Rocco²⁴  Barbaud, Annick^25,26 

[1] Vanderbilt Univ, Med Ctr, 1161 21st Ave South,A-2200 Med Ctr North, Nashville, TN 37332 USA

[2] Inst Immunol & Infect Dis, Murdoch, WA, Australia

[3] Univ Minnesota, Dept Dermatol, Dermatoallergy Div, Minneapolis, MN 55455 USA

[4] Univ Basel, Univ Hosp, Dept Dermatol, Allergy Unit, Basel, Switzerland

[5] Boston Childrens Hosp, Boston, MA USA

[6] Harvard Med Sch, Boston, MA USA

[7] Seoul Natl Univ, Coll Med, Bundang Hosp, Dept Internal Med, Seongnam, South Korea

[8] Chang Gung Mem Hosp, Drug Hypersensit Clin & Res Ctr, Dept Dermatol, Taipei, Taiwan

[9] Chang Gung Mem Hosp, Drug Hypersensit Clin & Res Ctr, Dept Dermatol, Linkou, Taiwan

[10] Chang Gung Mem Hosp, Drug Hypersensit Clin & Res Ctr, Dept Dermatol, Keelung, Taiwan

[11] Univ Cape Town, Dept Med, Div Dermatol, Rondebosch, South Africa

[12] Univ Cape Town, Dept Med, Combined Drug Allergy Clin, Rondebosch, South Africa

[13] Univ Freiburg, Med Ctr, Dept Dermatol, Dokumentat Zentrum Schwerer Hautreaktionen DZh, Freiburg, Germany

[14] Univ Freiburg, Fac Med, Freiburg, Germany

[15] Univ Liverpool, Dept Mol & Clin Pharmacol, Ctr Drug Safety Sci, Liverpool, Merseyside, England

[16] Univ ~ Paris Est Creteil, Creteil, France

[17] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Div Dermatol, Toronto, ON, Canada

[18] Univ Hosp Montpellier, Montpellier, France

[19] Sorbonne Univ, INSERM, Paris, France

[20] Hosp Sirio Libanes, Sao Paulo, Brazil

[21] Univ Melbourne, Austin Hlth, Dept Infect Dis, Heidelberg, Vic, Australia

[22] Univ Melbourne, Austin Hlth, Ctr Antibiot Allergy & Res, Heidelberg, Vic, Australia

[23] Peter MacCallum Canc Ctr, Dept Infect Dis, Natl Ctr Infect Canc, Parkville, Vic, Australia

[24] Pediat Hosp Bambino Gesu, Dept Allergy, Vatican City, Vatican

[25] Sorbonne Univ, Tenon Hosp, Dermatol & Allergy Dept, Paris, France

[26] AP HP, Paris, France

关键词: Delayed;    intradermal;    prick;    patch;    oral challenge;    HLA;    acute generalized exanthematous pustulosis;    fixed drug eruption;    drug reaction with eosinophilia and systemic symptoms;    Stevens-Johnson syndrome/toxic epidermal necrolysis;   

DOI  :  10.1016/j.jaci.2018.10.030

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

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