Halevy Sima, Grossman Nili
Department of Dermatology, Soroka University Medical Center, Beer Sheva, Israel.
Isr Med Assoc J. 2008 Dec;10(12):865-8.
Multiple drug allergy syndrome is a rarely reported clinical condition characterized by an adverse reaction to more than one different class of pharmacologically and structurally unrelated drugs. The pathogenesis may involve immediate-type or delayed-type hypersensitivity.
To further characterize patients with MDA in terms of the type of CADR, drug intake and clinical drug suspicion.
The study group comprised 12 patients (6 males, 6 females) with CADRs showing in vitro drug-induced IFNgamma release for multiple drugs, suggesting the presence of MDA. The diagnostic role of in vitro IFNgamma release in identifying the culprit drugs was evaluated in terms of clinical data and the results of in vivo tests (withdrawal and/or challenge tests) with the offending drugs.
Clinical relevance was attributed to in vitro drug-induced IFNgamma release towards multiple drugs in this series of 12 patients with a variety of CADRs, implying MDA. The results of in vivo tests for the offending drugs confirmed the diagnosis. The main causative agents responsible were antibiotics and non-steroidal anti-inflammatory drugs.
The study further supports the role of a T cell-mediated mechanism in the pathogenesis of MDA. The in vitro drug-induced IFNgamma release test may serve as a laboratory tool to identify the culprit drugs associated with this allergy.
多种药物过敏综合征是一种临床报道较少的病症，其特征为对超过一种不同种类的药理和结构不相关药物产生不良反应。发病机制可能涉及速发型或迟发型超敏反应。
根据不良反应类型、药物摄入情况及临床药物怀疑情况，进一步明确多种药物过敏患者的特征。
研究组包括12例患者（6例男性，6例女性），这些患者出现了体外药物诱导的多种药物IFNγ释放的不良反应，提示存在多种药物过敏。根据临床数据以及对可疑药物进行的体内试验（撤药和/或激发试验）结果，评估体外IFNγ释放在识别可疑药物方面的诊断作用。
在这12例患有各种不良反应的患者中，体外药物诱导的多种药物IFNγ释放具有临床相关性，提示存在多种药物过敏。对可疑药物的体内试验结果证实了诊断。主要致病药物为抗生素和非甾体抗炎药。
该研究进一步支持了T细胞介导机制在多种药物过敏发病机制中的作用。体外药物诱导的IFNγ释放试验可作为一种实验室工具，用于识别与此过敏相关的可疑药物。
