Agmon-Levin Nancy, Tal Yuval, Broides Arnon, Asher Ilan, Hersheko Alon, Staubers Tali, Confino-Cohen Ronit
Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel.
Allergy and Clinical Immunology Unit, Hadassah Medical Center and Hebrew University Medical School, Jerusalem, Israel.
Harefuah. 2013 Sep;152(9):506-12, 565.
Drug hypersensitivity is an adverse reaction that was brought about by a specific immunologic response, not related to the pharmacological components of the drug. Additionally, drug related pseudoallergic and anaphylactoid reactions have been encompassed under the umbrella of hypersensitivity. Some of these reactions are linked with significant morbidity and mortality. Nowadays, the hypersensitivity reactions of most drugs can be well defined and recurrence risk following exposure to the culprit drug and/or related drugs can be assessed. Medical history skin, blood and challenge tests, conducted in an allergy clinic, enable prediction and prevention of repeated events as well as unnecessary avoidance of certain compounds. For instance, most patients who report a prior reaction to penicillin are not allergic to beta-lactams upon allergic evaluation, while avoidance of penicillin based on self-reporting alone often leads to the use of an alternate antibiotic with greater cost or side effect profile. On the other hand, for patients who previously exhibited hypersensitivity to a compound which is currently required, premedication or a desensitization protocol can be recommended to allow the use of this compound. Drug hypersensitivity is most commonly attributed to beta-lactams antibiotics, contrast media reagents and non-steroidal anti-inflammatory drugs (NSAID). Hence, in the current review the recommendations of the Israeli Association for Allergy and Clinical Immunology for the evaluation and treatment of patients suspected to have hypersensitivity to beta-lactams and contrast media reagents are detailed. Recommendations regarding the evaluation of NSAID hypersensitivity will be published on the IMA website, together with those explicated herein.
药物超敏反应是一种由特定免疫反应引起的不良反应，与药物的药理成分无关。此外，药物相关的假过敏反应和类过敏反应也被纳入超敏反应的范畴。其中一些反应与显著的发病率和死亡率相关。如今，大多数药物的超敏反应能够得到很好的界定，接触致病药物和/或相关药物后的复发风险也可以进行评估。在过敏诊所进行的病史询问、皮肤检查、血液检查和激发试验，能够预测和预防反复发生的事件，以及避免不必要地回避某些化合物。例如，大多数报告曾对青霉素有过反应的患者，在进行过敏评估时对β-内酰胺类药物并无过敏，而仅基于自我报告就避免使用青霉素，往往会导致使用成本更高或副作用更大的替代抗生素。另一方面，对于之前对目前所需化合物表现出超敏反应的患者，可以推荐进行预处理或脱敏方案，以允许使用该化合物。药物超敏反应最常见于β-内酰胺类抗生素、造影剂和非甾体抗炎药（NSAID）。因此，在本综述中，详细介绍了以色列过敏与临床免疫学会对疑似对β-内酰胺类药物和造影剂超敏患者的评估和治疗建议。关于NSAID超敏反应评估的建议将与本文阐述的内容一起发布在以色列医学协会网站上。
