Mori Francesca, Blanca-Lopez Natalia, Caubet Jean-Christoph, Demoly Pascal, Du Toit George, Gomes Eva R, Kuyucu Semanur, Romano Antonino, Soyer Ozge, Tsabouri Sophia, Atanaskovic-Markovic Marina
Allergy Unit, Department of Pediatric Medicine, Meyer Children's Hospital, Florence, Italy.
Allergy Unit, Infanta Leonor University Hospital, Madrid, Spain.
Pediatr Allergy Immunol. 2021 Apr;32(3):425-436. doi: 10.1111/pai.13409. Epub 2020 Dec 18.
Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life-threatening.
This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature.
Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids.
Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. There is therefore an ongoing need to improve our knowledge of HS reactions due to AED medications and in particular to improve our diagnostic capabilities.
抗癫痫药物（AEDs）广泛用于治疗癫痫，但它们可能主要与迟发性/非即时性过敏反应（HRs）的发生有关。尽管这些反应通常为皮肤性，具有自限性，且在停药后数天内可自行消退，但有时AEDs引起的HR反应可能很严重并危及生命。
本文旨在通过回顾文献中已知的内容，展示儿童AED HRs实际管理的实例。
危险因素包括年龄、既往AEDs反应史、病毒感染、合并用药和遗传因素。诊断检查包括体内（皮内试验和斑贴试验）和体外试验[血清学调查以排除病毒感染的作用、淋巴细胞转化试验（LTT）、酶联免疫斑点分析中的细胞因子检测以及流式细胞术中的颗粒溶素（Grl）]。治疗基于迅速停药，主要使用糖皮质激素。
处理AED HRs具有挑战性。AEDs所致HRs诊断和管理的首要目标应是试图准确识别病因触发因素，同时确定一种安全有效的替代抗惊厥药物。因此，持续需要提高我们对AED药物引起的HS反应的认识，特别是提高我们的诊断能力。
