Castells Mariana
Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Front Immunol. 2017 Nov 8;8:1472. doi: 10.3389/fimmu.2017.01472. eCollection 2017.
Drug allergy is a rising problem in the twenty-first century which affects all populations and races, children, and adults, and for which the recognition, diagnosis, management, and treatment is still not well standardized. Classical and new chemotherapy drugs, monoclonal antibodies (MoAbs), and small molecules to treat cancer and chronic inflammatory diseases are aimed at improving quality of life and life expectancy of patients, but an increasing number of reactions including anaphylaxis precludes their use in targeted populations. Women are more affected by drug allergy and up to 27% of women with ovarian and breast cancer develop carboplatin allergy after multiple cycles of treatment. Carriers of BRCA genes develop drug allergy after fewer exposures and can present with severe reactions, including anaphylaxis. Atopic patients are at increased risk for chemotherapy and MoAbs drug allergy and the current patterns of treatment with recurrent and intermittent drug exposures may favor the development of drug allergies. To overcome drug allergy, desensitization has been developed, a novel approach which provides a unique opportunity to protect against anaphylaxis and to improve clinical outcomes. There is evidence that inhibitory mechanisms blocking IgE/antigen mast cell activation are active during desensitization, enhancing safety. Whether desensitization modulates drug allergic and anaphylactic responses facilitating tolerance is currently being investigated. This review provides insight into the current knowledge of drug allergy and anaphylaxis to cancer and chronic inflammatory diseases drugs, the mechanisms of drug desensitization and its applications to personalized medicine.
药物过敏是21世纪日益突出的问题,影响所有人群和种族,包括儿童和成人,而对其的识别、诊断、管理和治疗仍未得到很好的规范。用于治疗癌症和慢性炎症性疾病的经典化疗药物、单克隆抗体(MoAbs)和小分子药物旨在提高患者的生活质量和预期寿命,但包括过敏反应在内的不良反应越来越多,这使得它们无法在目标人群中使用。女性受药物过敏的影响更大,多达27%的卵巢癌和乳腺癌女性在接受多个周期治疗后会发生卡铂过敏。携带BRCA基因的人在接触较少药物后就会发生药物过敏,并可能出现严重反应,包括过敏反应。特应性患者发生化疗和单克隆抗体药物过敏的风险增加,而目前反复和间歇性接触药物的治疗模式可能有利于药物过敏的发生。为了克服药物过敏,已经开发出脱敏疗法,这是一种新方法,为预防过敏反应和改善临床结果提供了独特的机会。有证据表明,在脱敏过程中,阻断IgE/抗原肥大细胞活化的抑制机制是活跃的,从而提高了安全性。目前正在研究脱敏是否能调节药物过敏和过敏反应,促进耐受性。这篇综述深入探讨了目前关于癌症和慢性炎症性疾病药物的药物过敏和过敏反应的知识、药物脱敏的机制及其在个性化医疗中的应用。