Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp, Antwerp University Hospital, Belgium.
Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
Clin Chim Acta. 2016 Sep 1;460:184-9. doi: 10.1016/j.cca.2016.06.043. Epub 2016 Jul 1.
For many physicians, quantification of serum drug-specific IgE (sIgE) antibodies constitutes the first measure in the diagnostic approach of immediate drug hypersensitivity reactions (IDHR).
To review the accuracy and limitations of the main drug-sIgE tests, especially those that are commercially available.
A literature search was conducted, using the key-words allergy, diagnosis, drugs, hypersensitivity, specific IgE antibodies; this was complemented by the authors' own experience.
The drugs that have mostly been studied appeared to be β-lactam antibiotics, neuromuscular blocking agents (NMBA) and morphine, the latter as a biomarker for sensitisation to substituted ammonium structures that constitute the major epitope of NMBA. For β-lactams sensitivity and specificity varied between 0-85% and 52-100%, respectively. For NMBA, sensitivity and specificity varied between 38.5-92% and 92-100%, respectively. With respect to sIgE to morphine it appears this drug to be a sensitive biomarker for sensitisation to rocuronium and suxamethonium but not for atracurium. However, sIgE morphine should not be applied in isolation to diagnose IDHR to NMBA nor opiates.
Although drug-sIgE assay can provide valuable information they should not be performed in isolation to establish correct diagnosis, as their predictive value is not per se absolute. Larger comprehensive studies are urgently required to determine the accuracy of drug-sIgE assays.
对于许多医生来说，血清药物特异性 IgE（sIgE）抗体的定量检测构成了即时药物过敏反应（IDHR）诊断方法的第一步。
回顾主要药物-sIgE 检测的准确性和局限性，特别是那些商业上可获得的检测方法。
使用关键词“过敏、诊断、药物、过敏反应、特异性 IgE 抗体”进行文献检索，同时补充作者自己的经验。
研究最多的药物似乎是β-内酰胺类抗生素、神经肌肉阻滞剂（NMBA）和吗啡，后者是对构成 NMBA 主要表位的取代铵结构敏感的生物标志物。对于β-内酰胺类抗生素，敏感性和特异性分别在 0-85%和 52-100%之间变化。对于 NMBA，敏感性和特异性分别在 38.5-92%和 92-100%之间变化。关于吗啡的 sIgE，似乎该药是对罗库溴铵和琥珀胆碱敏感的敏感生物标志物，但不是对阿曲库铵敏感。然而，sIgE 吗啡不应用于孤立诊断 NMBA 或阿片类药物的 IDHR。
虽然药物-sIgE 检测可以提供有价值的信息，但不应孤立进行以确立正确的诊断，因为其预测值本身并不是绝对的。迫切需要进行更大规模的综合研究来确定药物-sIgE 检测的准确性。
