Department of Allergy, E Durkheim Hospital, Epinal, France.
Allergy. 2013 Jul;68(7):929-37. doi: 10.1111/all.12168. Epub 2013 Jun 6.
A few series of well-documented cases of severe drug-induced anaphylaxis (SDA) are available.
Cases collected by the Allergy Vigilance Network from 2002 to 2010 were analyzed for clinical signs, causative drugs, and efficacy of a stepwise approach to diagnosis, using skin tests, laboratory tests, and oral challenges.
Three hundred and thirty-three cases concerned 300 adults (90.1%) and 33 children (9.9%): 206 females (61.9%) and 127 males (38.1%). Mean age was 42.7 ± 18 years. Anaphylactic shock (76.6%), severe systemic reactions (10.5%), acute laryngeal edema (9%), severe bronchospasm (2.1%), and six fatal cases (1.8%) were recorded. There were 270 cases (81.1%) of ambulatory anaphylaxis. Sixty-three cases (18.9%) occurred during anesthesia. Hospitalization was required in 94.8% of cases. 23.7% of patients were admitted to an intensive care unit. Epinephrine was used in 57.9% of cases. Eighty-four drugs were incriminated: antibiotics (49.6%), muscle relaxants, latex and anesthetics (15%), nonsteroidal anti-inflammatory drugs (10.2%), acetaminophen (3.9%), iodinated or magnetic resonance imaging contrast media (4.2%), immunotherapy and vaccines (3.9%), and other drugs (13%). Among antibiotics, amoxicillin (97 cases), other penicillins (four cases), cephalosporins (41 cases), quinolones (15 cases), and pristinamycin (seven cases) were the most common. The diagnosis of drug hypersensitivity was obtained by skin tests in 72.9%, laboratory tests only in 2.4% of cases, and oral challenges (OCs) only in 3.9% of cases.
Three hundred and thirty-three case reports provided data on drugs involved in severe anaphylaxis. The efficacy of skin tests and poor use of laboratory tests are underlined. Further progress may depend on OCs.
有一些经过充分记录的严重药物诱导过敏反应（SDA）的病例系列。
2002 年至 2010 年，过敏监测网络收集的病例进行了分析，分析内容包括临床体征、致病药物，以及逐步诊断方法（包括皮肤试验、实验室检查和口服激发试验）的疗效。
333 例病例涉及 300 名成年人（90.1%）和 33 名儿童（9.9%）：206 名女性（61.9%）和 127 名男性（38.1%）。平均年龄为 42.7±18 岁。记录了 76.6%的过敏性休克、10.5%的严重全身反应、9%的急性喉水肿、2.1%的严重支气管痉挛和 6 例死亡病例（1.8%）。有 270 例（81.1%）为门诊过敏反应。63 例（18.9%）发生在麻醉期间。94.8%的病例需要住院治疗。23.7%的患者入住重症监护病房。57.9%的病例使用肾上腺素。共涉及 84 种药物：抗生素（49.6%）、肌肉松弛剂、乳胶和麻醉剂（15%）、非甾体抗炎药（10.2%）、对乙酰氨基酚（3.9%）、碘或磁共振成像造影剂（4.2%）、免疫疗法和疫苗（3.9%）和其他药物（13%）。在抗生素中，阿莫西林（97 例）、其他青霉素（4 例）、头孢菌素（41 例）、喹诺酮类（15 例）和普林霉素（7 例）最为常见。药物过敏的诊断通过皮肤试验获得的占 72.9%，仅通过实验室检查获得的占 2.4%，仅通过口服激发试验获得的占 3.9%。
333 例病例报告提供了严重过敏反应相关药物的数据。皮肤试验的有效性和实验室检查的应用不足得到了强调。进一步的进展可能取决于口服激发试验。
