Srinoulprasert Yuttana, Rerkpattanapipat Ticha, Sompornrattanaphan Mongkhon, Wongsa Chamard, Kanistanon Duangjit
Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Asia Pac Allergy. 2020 Oct 29;10(4):e44. doi: 10.5415/apallergy.2020.10.e44. eCollection 2020 Oct.
Drug hypersensitivity reactions (DHRs) occasionally present with severe cutaneous adverse reactions (SCARs) which result in a high risk of morbidity and mortality. Although SCARs are rare, the occurrence could lead to a significant increase in healthcare and economic burden, especially when more than one possible culprit drug is implicated. Therefore, the accurate identification of the culprit drug(s) is important for correct labeling and subsequent patient education and avoidance. To date, clinical evaluation using causality assessment has limitations because the assessment may be inaccurate due to the overlapping timelines when multiple drugs are initiated/continued. Moreover, drug provocation tests (DPTs) which is the gold standard in diagnosis, are contraindicated, and skin tests may also be associated with risks of triggering SCAR. The European Network for Drug Allergy recommended that tests, if available, should be performed before any tests. Basophil activation tests and lymphocyte transformation tests, could serve as reliable tests for both immediate and delayed-type DHR. Many academic medical centers with affiliated laboratory services offer these tests in the diagnostic evaluation of SCARs in clinical practice. This not only complements identification of the culprit drug(s), but may also be used to test for potentially non cross-reactive alternatives, hence avoiding DPTs. In this review, we summarize the roles of tests in identifying the culprit drug(s) in SCARs, issues with utilization and interpretation of test results, and our experience in clinical practice.
药物超敏反应（DHRs）偶尔会出现严重皮肤不良反应（SCARs），这会导致较高的发病和死亡风险。尽管SCARs很少见，但它的发生可能会显著增加医疗保健和经济负担，尤其是当涉及一种以上可能的致病药物时。因此，准确识别致病药物对于正确标注以及后续的患者教育和避免再次接触至关重要。迄今为止，使用因果关系评估的临床评估存在局限性，因为当多种药物开始使用/持续使用时，由于时间线重叠，评估可能不准确。此外，作为诊断金标准的药物激发试验（DPTs）是禁忌的，皮肤试验也可能与引发SCAR的风险相关。欧洲药物过敏网络建议，如果有可用的检测，应在任何其他检测之前进行。嗜碱性粒细胞活化试验和淋巴细胞转化试验可作为速发型和迟发型DHR的可靠检测方法。许多拥有附属实验室服务的学术医疗中心在临床实践中对SCARs的诊断评估中提供这些检测。这不仅有助于补充致病药物的识别，还可用于检测潜在的非交叉反应性替代药物，从而避免进行药物激发试验。在本综述中，我们总结了这些检测在识别SCARs致病药物中的作用、检测结果的利用和解释问题以及我们在临床实践中的经验。
