药物过敏/超敏反应的诊断程序与实践：对13个亚洲国家的调查
Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries.
作者信息
Tang Min-Moon, Fok Jie Shen, Thong Bernard Yu-Hor, Yun James, Li Philip Hei, Kang Hye-Ryun, Thien Francis, Yamaguchi Masao, Lucas Michaela, Chang Yoon-Seok, Kim Byung-Keun, Nagao Mizuho, Rengganis Iris, Tsai Yi-Giien, Chung Wen-Hung, Rerkpattanapipat Ticha, Kamchaisatian Wasu, Leung Ting Fan, Ho Joo-Yoon, Zhang Luo, Latiff Amir Hamzah Abdul, Fujisawa Takao, Castells Mariana C, Demoly Pascal, Wang Jiu Yao, Pawankar Ruby
机构信息
Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Department of Respiratory Medicine, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia.
出版信息
Asia Pac Allergy. 2020 Oct 15;10(4):e36. doi: 10.5415/apallergy.2020.10.e36. eCollection 2020 Oct.
BACKGROUND
The issues and challenges in the diagnosis of drug allergy/hypersensitivity among children and adults in Asia are likely to be different from non-Asian countries.
OBJECTIVE
To study the diagnostic modalities used in the evaluation and management of drug allergy/drug hypersensitivity reactions (DHRs) among member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI).
METHODS
A questionnaire comprising 41 questions was circulated electronically to member societies and individual members of APAAACI between January 23, 2020 and March 6, 2020.
RESULTS
Twenty-six respondents from 15 member societies and 1 individual member responded. European DHR guidelines were most commonly used. Skin prick and intradermal testing was used by 100%, with only 60% having access to commercial penicillin skin test reagents. -specific IgE tests were used by 75%, and basophil activation test by 56.3% for immediate DHR. Patch tests were used by 75% in contrast to lymphocyte transformation tests by 25% for nonimmediate DHR. Drug provocation tests were used by 68.8%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (93.3%). Human leukocyte antigen (HLA) genotype testing was mandatory among 25% respondents before new carbamazepine prescriptions, and 8.3% for allopurinol prescriptions.
CONCLUSIONS
There was increased use of skin testing for iodinated contrast media hypersensitivity and patch testing for nonimmediate DHR. HLA genotype testing prior to new carbamazepine, allopurinol and abacavir prescriptions remain variable despite strong associations for severe cutaneous adverse reactions with Asian ethnicity. Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across APAAACI member societies.
背景
亚洲儿童和成人药物过敏/超敏反应诊断中的问题和挑战可能与非亚洲国家不同。
目的
研究亚太过敏、哮喘与临床免疫学会（APAAACI）成员学会在药物过敏/药物超敏反应（DHR）评估和管理中使用的诊断方法。
方法
2020年1月23日至2020年3月6日期间，通过电子邮件向APAAACI的成员学会和个人成员发放了一份包含41个问题的问卷。
结果
来自15个成员学会的26名受访者和1名个人成员做出了回应。欧洲DHR指南使用最为普遍。100%的受访者使用皮肤点刺试验和皮内试验，只有60%的人能够获得商用青霉素皮肤试验试剂。75%的受访者使用特异性IgE检测，56.3%的人使用嗜碱性粒细胞活化试验来诊断速发型DHR。75%的受访者使用斑贴试验，相比之下，25%的人使用淋巴细胞转化试验来诊断迟发型DHR。68.8%的受访者使用药物激发试验，最常见的指征是在病史/症状不提示药物超敏反应/过敏时排除超敏反应（93.3%）。25%的受访者在新开卡马西平处方前强制进行人类白细胞抗原（HLA）基因分型检测，8.3%的受访者在新开别嘌醇处方前进行此项检测。
结论
对于碘化造影剂超敏反应，皮肤试验的使用有所增加；对于迟发型DHR，斑贴试验的使用有所增加。尽管亚洲人种与严重皮肤不良反应有很强的相关性，但在新开卡马西平、别嘌醇和阿巴卡韦处方前进行HLA基因分型检测仍然存在差异。本次调查结果为制定教育和培训需求以及改善APAAACI各成员学会的药物过敏诊断和治疗方法提供了一个有用的框架。
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