Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Indian J Dermatol Venereol Leprol. 2010 Jul-Aug;76(4):382-6. doi: 10.4103/0378-6323.66587.
Some patients report hypersensitivity reactions to many drugs making it difficult to prescribe medications when they fall ill.
To describe the clinical profile of multiple drug hypersensitivity and the results of challenge testing in a large teaching hospital.
We performed a five-year retrospective review of the records of patients who complained of reactions to two or more unrelated drugs and avoided medication because of a fear of developing reactions. Oral challenge testing was carried out in hospital with drugs suspected by the patient to cause reactions and/or commonly prescribed medications. A positive reaction was diagnosed when symptoms and signs resembled previously experienced episodes and there was no such reaction with placebo.
Twenty three patients (aged 14-65 years; 19 females) underwent challenge testing. Their complaints had been present for 1-30 years, with 2-40 drug reaction episodes reported. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) were most commonly implicated, and urticaria/angioedema were the most often reported manifestations. The patients underwent 3-27 challenges with 1-24 drugs. Three had positive challenge reactions with various NSAIDs, 13 developed symptoms and signs that were judged not to be true reactions, and 7 had no reactions. None of our patients qualified for a diagnosis of true multiple drug hypersensitivity.
Patients who believe they are allergic to multiple, pharmacologically unrelated drugs are usually mistaken. Challenge testing is a reliable way of demonstrating this and providing patients with a list of safe drugs.
一些患者报告对多种药物过敏，导致他们生病时难以开处方。
描述大型教学医院中多位药物过敏的临床特征和挑战测试结果。
我们对因担心发生反应而避免用药的、报告对两种或多种无关药物过敏的患者的记录进行了为期五年的回顾性研究。在医院对患者怀疑引起反应的药物和/或常用药物进行口服挑战测试。当症状和体征与之前经历过的发作相似且与安慰剂无此类反应时，诊断为阳性反应。
23 名患者（年龄 14-65 岁；19 名女性）接受了挑战测试。他们的抱怨已经存在 1-30 年，报告了 2-40 次药物反应发作。抗生素和非甾体抗炎药（NSAIDs）最常被牵连，荨麻疹/血管性水肿是最常报告的表现。患者接受了 3-27 次挑战测试，涉及 1-24 种药物。有 3 人对各种 NSAIDs 有阳性挑战反应，13 人出现被判断为非真实反应的症状和体征，7 人无反应。我们的患者均不符合真正的多位药物过敏诊断。
认为自己对多种药物过敏的患者通常是错误的。挑战测试是证明这一点并为患者提供安全药物清单的可靠方法。
