van der Poorten Marie-Line M, Van Gasse Athina L, Hagendorens Margo M, Faber Margaretha A, De Puysseleyr Leander, Elst Jessy, Mertens Christel M, Sabato Vito, Ebo Didier G
Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Department of Paediatrics, University of Antwerp, and Antwerp University Hospital, Antwerp, Belgium.
Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
Clin Chim Acta. 2020 May;504:119-124. doi: 10.1016/j.cca.2020.02.005. Epub 2020 Feb 6.
Immediate drug hypersensitivity reactions (IDHRs) constitute a significant health problem that may be compounded by consequences of diagnostic error. In daily practice, IDHR diagnostic work up starts with drug-specific skin testing and/or quantification of specific IgE (sigE) antibodies in serum. Here we critically review the performance, i.e. potential and limitations of sIgE to β-lactam antibiotics (β-LABs), curarizing neuromuscular blocking agents (NMBAs), opiates and (semi)synthetic opioids, fluoroquinolones (FQs), poppy seed (papaver somniferum), chlorhexidine and finally Hevea latex. Quintessence of these studies is clear. Quantification of these drug-specific sIgE should not be used in isolation to document or exclude diagnosis of an IDHR. False negative results entail the risk for subsequent potentially life-threatening anaphylaxis upon re-exposure. False positive results lead to erroneous avoidance and unnecessary substitutions and fails to identify the true etiology.
速发型药物过敏反应（IDHRs）是一个重大的健康问题，诊断错误可能会使其更加复杂。在日常实践中，IDHR的诊断工作从药物特异性皮肤试验和/或血清中特异性IgE（sigE）抗体的定量开始。在此，我们批判性地回顾了sIgE针对β-内酰胺类抗生素（β-LABs）、箭毒样神经肌肉阻滞剂（NMBAs）、阿片类药物和（半）合成阿片类药物、氟喹诺酮类（FQs）、罂粟籽（罂粟）、洗必泰和最后天然橡胶的性能，即潜力和局限性。这些研究的要点很明确。这些药物特异性sIgE的定量不应单独用于记录或排除IDHR的诊断。假阴性结果会带来再次接触后随后发生潜在危及生命的过敏反应的风险。假阳性结果会导致错误的避免和不必要的替代，并且无法识别真正的病因。
