Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey.
Curr Pharm Des. 2019;25(36):3881-3901. doi: 10.2174/1381612825666191106115556.
Severe cutaneous drug hypersensitivity reactions involve of different mechanisms , some of which are life-threatening, such as Stevens-Johnson syndrome/toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, generalized bullous fixed drug eruptions, serum sickness and serum sickness-like reaction and drug-induced vasculitis. These reactions may have substantial morbidity and mortality. In the past years, successive studies have provided new evidence regarding the pathogenesis of some of these severe reactions and revealed that underlying mechanisms are highly variable. Since these reactions have unique presentations and distinct pathomechanisms, the treatment methods and response rates might be different among various entities. Although supportive and local therapies are sufficient in some of these reactions, targeted immunosuppressive treatments and even mechanistic therapies such as plasmapheresis may be required in severe ones. However, there is still insufficient evidence to support the best treatment options for these patients since number of patients and large-scale studies are limited. In this review, conventional and new treatment options for severe cutaneous drug hypersensitivity reactions are presented in detail in order to provide the contemporary approaches to lessen the morbidity and mortality relevant to these severe iatrogenic diseases.
严重的皮肤药物超敏反应涉及不同的机制，其中一些是危及生命的，如史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症、药物反应伴嗜酸性粒细胞增多和全身症状、急性泛发性发疹性脓疱病、全身性大疱性固定性药物疹、血清病和血清病样反应以及药物诱导的血管炎。这些反应可能有很高的发病率和死亡率。在过去的几年中，连续的研究为这些严重反应的一些发病机制提供了新的证据，并揭示了潜在的机制高度可变。由于这些反应具有独特的表现和不同的病理机制，因此各种实体之间的治疗方法和反应率可能不同。尽管在一些反应中支持性和局部治疗是足够的，但在严重的反应中可能需要靶向免疫抑制治疗甚至机械治疗，如血浆置换。然而，由于患者数量和大规模研究有限，仍然没有足够的证据支持这些患者的最佳治疗选择。在这篇综述中，详细介绍了严重皮肤药物超敏反应的传统和新的治疗选择，以提供当代方法来减轻这些严重医源性疾病相关的发病率和死亡率。
