Torres María J, Salas Maria, Ariza Adriana, Fernández Tahia D
aAllergy Unit bResearch Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Malaga, Spain.
Curr Opin Allergy Clin Immunol. 2016 Aug;16(4):308-14. doi: 10.1097/ACI.0000000000000285.
The purpose is to understand the underlying mechanisms of accelerated allergic reactions to drugs, defined here as reactions occurring between 1 and 24 h after drug intake.
Recent publications have shown that accelerated reactions are T cell-mediated, although an IgE mechanism cannot be ruled out in some cases.
Classification of allergic reactions to drugs is complex. Based on the time interval between drug administration and appearance of the clinical reaction, as well as the type of clinical symptoms, they can be classified as: immediate, typically appearing from less than 1 to 6 h after the last drug administration and nonimmediate, occurring at any time from 1 h after drug administration. Therefore, overlap exists in what the Levine classification defined as accelerated reactions, where clinical symptoms are mainly urticaria and less often exanthema and serum sickness-like reactions. The immunological mechanisms involved suggest that they are T cell-mediated reactions with a Th1 pattern, comprising increased production of IFNγ, TNFα, the chemokine CXCL9 and its corresponding receptor CXCR3. In most cases an IgE-mediated response is ruled out because of negative immediate skin test results, no detection of serum-specific IgE antibodies or tryptase, and no skin-secreted tryptase. However, an IgE-mediated response can be demonstrated in exceptional situations. Finally, serum sickness-like reactions have been reported as an immune complex-mediated accelerated reaction. However, the exact mechanism has not been confirmed.
目的是了解药物加速过敏反应的潜在机制，此处定义为服药后1至24小时内发生的反应。
近期发表的文章表明，加速反应是由T细胞介导的，尽管在某些情况下不能排除IgE机制。
药物过敏反应的分类很复杂。根据给药与临床反应出现之间的时间间隔以及临床症状类型，可分为：速发型，通常在最后一次给药后不到1至6小时出现；非速发型，在给药后1小时后的任何时间发生。因此，Levine分类中定义的加速反应存在重叠，其临床症状主要为荨麻疹，较少为皮疹和血清病样反应。所涉及的免疫机制表明它们是具有Th1模式的T细胞介导反应，包括IFNγ、TNFα、趋化因子CXCL9及其相应受体CXCR3的产生增加。在大多数情况下，由于即时皮肤试验结果为阴性、未检测到血清特异性IgE抗体或类胰蛋白酶以及皮肤分泌的类胰蛋白酶未检测到，排除了IgE介导的反应。然而，在特殊情况下可以证明存在IgE介导的反应。最后，血清病样反应已被报道为免疫复合物介导的加速反应。然而，确切机制尚未得到证实。
