Tal Yuval, Hersheko Alon, Broides Arnon, Asher Iran, Staubers Tali, Confino-Cohen Ronit, Agmon-Levin Nancy
Harefuah. 2014 Oct;153(10):605-9, 623.
Drug hypersensitivity is an adverse reaction that was brought-about by a specific immunologic response. Some of these reactions are Linked with significant morbidity and mortality. Nowadays, hypersensitivity reactions to most drugs can be well defined and the risk of re-exposure to the culprit drug and/or related drugs can be properly assessed. Medical history, skin, blood and challenge tests, conducted in an allergy clinic, enable the prediction and prevention of repeated events as well as unnecessary avoidance of needed compounds. Non-steroidal anti-inflammatory drugs [NSAID] are the second most prevalent group of drugs that provoke hypersensitivity responses occurring either immediately or later. Immediate type responses to NSAID could be divided into 2 groups, each related to a different mechanism. The most common reaction is not allergic but rather it is mediated by the inhibition of the cyclooxygenase I enzyme pathway. Accordingly, this reaction is not selective to a single chemical compound but rather cross-reacts with other members of this "family" of drugs, depending on their biochemical properties. The clinical distinction between those two subtypes of immediate reaction is hard and sometimes utterly impossible. Moreover, the clinical appearance of an immediate reaction may vary from rhinitis, asthma, new appearance or augmentation of chronic urticaria and up to overt anaphylaxis and death. Furthermore, delayed type reactions may also be life-threatening and typically appear 24 hours and up to days following initiation of therapy. In the current review, we present the recommendations of the Israel Association for Allergy and Clinical Immunology for the evaluation and treatment of patients suspected to suffer from hypersensitivity to NSAIDs.
药物超敏反应是由特定免疫反应引起的不良反应。其中一些反应与显著的发病率和死亡率相关。如今，对大多数药物的超敏反应能够得到很好的界定，再次接触致病药物和/或相关药物的风险也能得到恰当评估。在过敏诊所进行的病史、皮肤、血液及激发试验，有助于预测和预防反复发生的事件，以及避免不必要地回避所需药物。非甾体抗炎药（NSAID）是引发超敏反应的第二大常见药物类别，这些反应可立即发生或延迟出现。对NSAID的速发型反应可分为两组，每组与不同机制相关。最常见的反应并非过敏反应，而是由环氧化酶I酶途径的抑制介导。因此，这种反应并非对单一化合物具有选择性，而是会根据其他药物的生化特性与该“药物家族”的其他成员发生交叉反应。这两种速发型反应亚型之间的临床区分很困难，有时甚至完全不可能。此外，速发型反应的临床表现可能多种多样，从鼻炎、哮喘、慢性荨麻疹的新发或加重，到明显的过敏反应甚至死亡。此外，迟发型反应也可能危及生命，通常在开始治疗后24小时至数天内出现。在本综述中，我们介绍了以色列过敏与临床免疫学会对疑似NSAID超敏反应患者的评估和治疗建议。
