Thong Bernard Yu-Hor, Lucas Michaela, Kang Hye-Ryun, Chang Yoon-Seok, Li Philip Hei, Tang Min Moon, Yun James, Fok Jie Shen, Kim Byung-Keun, Nagao Mizuho, Rengganis Iris, Tsai Yi-Giien, Chung Wen-Hung, Yamaguchi Masao, Rerkpattanapipat Ticha, Kamchaisatian Wasu, Leung Ting Fan, Yoon Ho Joo, Zhang Luo, Latiff Amir Hamzah Abdul, Fujisawa Takao, Thien Francis, Castells Mariana C, Demoly Pascal, Wang Jiu-Yao, Pawankar Ruby
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
Department of Immunology, Pathwest and Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Perth, Australia.
Asia Pac Allergy. 2020 Jan 30;10(1):e8. doi: 10.5415/apallergy.2020.10.e8. eCollection 2020 Jan.
There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B1502 with carbamazepine SCAR, and HLA-B5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.
世界各地药物过敏反应（DHRs）患者的表型和内型存在地理、区域和种族差异。在亚洲，具有区域重要性的药物过敏方面包括IgE介导的过敏反应和T细胞介导的反应，如对β-内酰胺类抗生素、抗结核药物、非甾体抗炎药（NSAIDs）和放射性造影剂的严重皮肤不良反应（SCARs）。在索引反应的药物合理性较低的情况下，已发现使用直接口服激发试验而非皮肤试验来消除低风险青霉素过敏标签是有用的。与亚洲相关的遗传风险关联包括在一些亚洲种族中，人类白细胞抗原（HLA）-B1502与卡马西平SCAR相关，以及HLA-B5801与别嘌醇SCAR相关。除了对一线抗结核治疗采用相对高风险的脱敏方案外，仍然缺乏安全准确的抗结核药物过敏诊断测试。NSAID过敏在亚洲的成人和儿童中都很常见，在表型上存在区域差异，尤其是在成人中。低剂量阿司匹林脱敏是具有交叉反应性NSAID过敏和经皮冠状动脉介入术后冠状动脉疾病患者的重要治疗方式。皮肤试验可让放射性造影剂过敏的患者确认可疑药物并测试替代药物，特别是在需要进行对比扫描以监测疾病复发或进展（尤其是癌症）的未来情况下。
