Stone Shelley F, Phillips Elizabeth J, Wiese Michael D, Heddle Robert J, Brown Simon G A
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research and the University of Western Australia, Perth, Western Australia; Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia.
Br J Clin Pharmacol. 2014 Jul;78(1):1-13. doi: 10.1111/bcp.12297.
Hypersensitivity reactions including anaphylaxis have been reported for nearly all classes of therapeutic reagents and these reactions can occur within minutes to hours of exposure. These reactions are unpredictable, not directly related to dose or the pharmacological action of the drug and have a relatively high mortality risk. This review will focus on the clinical presentation, immune mechanisms, diagnosis and prevention of the most serious form of immediate onset drug hypersensitivity reaction, anaphylaxis. The incidence of drug-induced anaphylaxis deaths appears to be increasing and our understanding of the multiple and complex reasons for the unpredictable nature of anaphylaxis to drugs is also expanding. This review highlights the importance of enhancing our understanding of the biology of the patient (i.e. immune response, genetics) as well as the pharmacology and chemistry of the drug when investigating, diagnosing and treating drug hypersensitivity. Misdiagnosis of drug hypersensitivity leads to substantial patient risk and cost. Although oral provocation is often considered the gold standard of diagnosis, it can pose a potential risk to the patient. There is an urgent need to improve and standardize diagnostic testing and desensitization protocols as other diagnostic tests currently available for assessment of immediate drug allergy are not highly predictive.
几乎所有种类的治疗试剂都曾报告过包括过敏反应在内的超敏反应，这些反应可在接触后数分钟至数小时内发生。这些反应不可预测，与剂量或药物的药理作用无直接关系，且有相对较高的死亡风险。本综述将聚焦于速发型药物超敏反应最严重的形式——过敏反应的临床表现、免疫机制、诊断及预防。药物性过敏反应死亡的发生率似乎在上升，我们对药物过敏反应不可预测性的多种复杂原因的理解也在不断扩展。本综述强调了在调查、诊断和治疗药物超敏反应时，加深对患者生物学特性（即免疫反应、遗传学）以及药物的药理学和化学性质理解的重要性。药物超敏反应的误诊会给患者带来巨大风险和成本。尽管口服激发试验常被视为诊断的金标准，但它可能给患者带来潜在风险。迫切需要改进和规范诊断检测及脱敏方案，因为目前用于评估速发型药物过敏的其他诊断试验预测性不高。
