Allergy and Clinical Immunology, Rochester Regional Health System, Rochester, NY, USA.
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Curr Allergy Asthma Rep. 2018 Mar 24;18(4):26. doi: 10.1007/s11882-018-0778-6.
Immune-mediated adverse drug reactions occur commonly in clinical practice and include mild, self-limited cutaneous eruptions, IgE-mediated hypersensitivity, and severe cutaneous adverse drug reactions (SCAR). SCARs represent an uncommon but potentially life-threatening form of delayed T cell-mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis (AGEP) to drug reaction with eosinophilia with systemic symptoms (DRESS), to the most severe form of illness, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
There is emerging literature on the efficacy of cyclosporine in decreasing mortality in SJS/TEN. The purpose of our review is to discuss the typical presentations of these conditions, with a special focus on identifying the culprit medication. We review risk factors for developing SCAR, including HLA alleles strongly associated with drug hypersensitivity. We conclude by discussing current strategies for the management of these conditions.
免疫介导的药物不良反应在临床实践中很常见，包括轻度、自限性皮疹、IgE 介导的过敏反应和严重的药物不良反应（SCAR）。SCAR 代表一种罕见但潜在危及生命的迟发性 T 细胞介导反应形式。疾病谱从急性全身性发疹性脓疱病（AGEP）到伴有全身症状的嗜酸性粒细胞增多症和药物反应（DRESS），到最严重的疾病史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）。
有越来越多的文献报道环孢素在降低 SJS/TEN 死亡率方面的疗效。我们的综述目的是讨论这些疾病的典型表现，特别关注确定罪魁祸首药物。我们回顾了发生 SCAR 的危险因素，包括与药物过敏强烈相关的 HLA 等位基因。最后，我们讨论了这些疾病的当前治疗策略。
