Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Allergy Asthma Proc. 2014 May-Jun;35(3):197-203. doi: 10.2500/aap.2014.35.3739.
Multiple drug allergy syndrome (MDAS) is a clinical diagnosis made in patients with adverse reactions to two or more structurally unrelated drugs with an underlying immune-mediated mechanism causing the reaction. The evaluation of a patient with MDAS begins with a comprehensive drug allergy history and consideration of the underlying immune mechanism for each reaction. Skin testing is a useful diagnostic tool; however, the only validated immediate hypersensitivity skin testing is for penicillin where the antigenic determinants have been identified. Skin testing to most other drugs, although not validated, can be considered using a nonirritating concentration (NIC). In general, skin test positivity using an NIC suggests that the drug should be avoided, but a negative result does not rule out an IgE-mediated allergy. A test dose, also called a drug provocation test, graded oral challenge, or incremental challenge, should be performed when there is a low likelihood of an IgE-mediated mechanism for the reaction. In patients with a recent IgE-mediated hypersensitivity reaction or positive skin testing with no reasonable alternative treatment options, desensitization protocols can be used to allow the patient to safely receive a necessary drug. The evaluation of patients with MDAS is both challenging and time-consuming for the practicing allergist, who must systematically evaluate each reaction to help determine which drugs can be safely used again in the future. The molecular mechanisms and risk factors for this condition remain poorly understood, but research to further understand this condition is ongoing.
多重药物过敏综合征（MDAS）是一种临床诊断，发生于对两种或两种以上结构上无关的药物产生不良反应的患者中，这些药物的反应机制为潜在的免疫介导。MDAS 患者的评估始于全面的药物过敏史和对每种反应的潜在免疫机制的考虑。皮肤试验是一种有用的诊断工具；然而，唯一经过验证的即刻过敏皮肤试验是青霉素，其抗原决定簇已被确定。虽然没有经过验证，但可以考虑使用非刺激性浓度（NIC）进行大多数其他药物的皮肤试验。一般来说，使用 NIC 进行皮肤试验阳性提示应避免使用该药物，但阴性结果并不能排除 IgE 介导的过敏。当反应的 IgE 介导机制不太可能时，应进行测试剂量，也称为药物激发试验、分级口服挑战或增量挑战。对于最近发生 IgE 介导的过敏反应或皮肤试验阳性但无合理替代治疗方案的患者，可以使用脱敏方案，使患者能够安全地使用必要的药物。对于过敏症专家来说，评估 MDAS 患者具有挑战性且耗时，必须系统地评估每种反应，以帮助确定哪些药物将来可以安全再次使用。该病症的分子机制和危险因素仍了解甚少，但正在进行进一步了解该病症的研究。
