Romano Antonino, Demoly Pascal
Allergy Unit of Integrated Complex Columbus, Catholic University of Sacred Heart, Rome, Italy.
Curr Opin Allergy Clin Immunol. 2007 Aug;7(4):299-303. doi: 10.1097/ACI.0b013e328216f4d4.
The present review addresses the most recent literature regarding the diagnosis of drug hypersensitivity reactions, which can be classified as immediate or nonimmediate according to the time interval between the last drug administration and the onset. Immediate reactions occur within 1 h; nonimmediate ones occur after more than 1 h.
Clinical and immunological studies suggest that type-I (IgE-mediated) and type-IV (cell-mediated) pathogenic mechanisms are involved in most immediate and nonimmediate reactions, respectively. New diagnostic tools, such as the basophil activation test and the lymphocyte activation test, have been developed and are under validation.
In diagnosis, the patient's history is fundamental; the allergologic examination includes in-vivo and in-vitro tests selected on the basis of the clinical features. Prick, patch, and intradermal tests are the most readily available forms of allergy testing. Determination of specific IgE levels is still the most common in-vitro method for diagnosing immediate reactions. The sensitivity of allergologic tests is not 100%; in selected cases, therefore, provocation tests are necessary. The routine use of the basophil activation test and the lymphocyte activation test could increase the sensitivity of diagnostic work-ups, thus reducing the need for drug provocation tests.
本综述探讨了关于药物过敏反应诊断的最新文献，根据最后一次用药与发病之间的时间间隔，药物过敏反应可分为速发型或非速发型。速发型反应在1小时内发生；非速发型反应在1小时后发生。
临床和免疫学研究表明，I型（IgE介导）和IV型（细胞介导）致病机制分别参与了大多数速发型和非速发型反应。新的诊断工具，如嗜碱性粒细胞活化试验和淋巴细胞活化试验，已经开发出来并正在进行验证。
在诊断中，患者的病史至关重要；过敏检查包括根据临床特征选择的体内和体外试验。点刺、斑贴和皮内试验是最常用的过敏检测形式。测定特异性IgE水平仍然是诊断速发型反应最常用的体外方法。过敏试验的敏感性并非100%；因此，在某些特定情况下，激发试验是必要的。常规使用嗜碱性粒细胞活化试验和淋巴细胞活化试验可以提高诊断检查的敏感性，从而减少药物激发试验的需求。
