Studer M, Waton J, Bursztejn A-C, Aimone-Gastin I, Schmutz J-L, Barbaud A
Service de Dermatologie, Hôpital de Brabois, CHU de Nancy, Bâtiment Philippe-Canton, 6, Rue du Morvan, 54511 Vandœuvre-lès-Nancy Cedex, France.
Ann Dermatol Venereol. 2012 May;139(5):375-80. doi: 10.1016/j.annder.2012.03.017. Epub 2012 Apr 25.
Multiple-drug hypersensitivity (MDH) in the literature concerns different entities. Our objective was to define its frequency and characteristics in patients examined for cutaneous adverse drug reaction (CADR) before studying genetic predisposition.
From a database comprising all patients referred for CADR between 2000 and 2010, we selected those meeting the following criteria: sensitisation to at least two chemically unrelated substances, as confirmed by positive skin tests or challenge tests. The following were excluded: patients with haematological diseases, HIV or chronic wounds and sensitization to the excipients.
Of the 1925 patients included, 11 (0.6%) were classed as polysensitized: eight women and three men, of mean age 62 years, presenting 2.5 episodes of drug hypersensitivity per patient. Four cases of DRESS were noted.
The strict criteria stipulated for this study enabled us to select patients with MDH, and to affirm that while it does in fact exist, it seems rare. Compared to polysensitized patients described in the literature, we preferred to distinguish between three groups of MDH: one occurring with different substances in separate episodes of CADR, one occurring with different substances during the same episode of CADR, and one occurring during DRESS and correlating with viral replication.
MDH exists and genetic predisposition could be investigated by studying cytokine polymorphism in such patients. However, because of its rarity, it is impossible to rule out fortuitous association of two episodes of CADR in the same patient.
文献中的多药过敏（MDH）涉及不同的实体。我们的目标是在研究遗传易感性之前，确定接受皮肤药物不良反应（CADR）检查的患者中MDH的发生率和特征。
从一个包含2000年至2010年间所有因CADR转诊患者的数据库中，我们选择了符合以下标准的患者：经皮肤试验或激发试验证实对至少两种化学结构不相关的物质过敏。排除以下患者：血液系统疾病患者、HIV感染者、慢性伤口患者以及对辅料过敏者。
在纳入的1925例患者中，11例（0.6%）被归类为多敏患者：8名女性和3名男性，平均年龄62岁，每位患者出现2.5次药物过敏发作。记录到4例药物超敏反应伴嗜酸性粒细胞增多和系统症状（DRESS）。
本研究规定的严格标准使我们能够选择MDH患者，并确认虽然MDH确实存在，但似乎很罕见。与文献中描述的多敏患者相比，我们更倾向于将MDH分为三组：一组在CADR的不同发作中由不同物质引起，一组在CADR的同一发作中由不同物质引起，一组在DRESS期间发生且与病毒复制相关。
MDH确实存在，可以通过研究此类患者的细胞因子多态性来调查遗传易感性。然而，由于其罕见性，无法排除同一患者两次CADR发作偶然关联的可能性。
