Unit of Antibodies in Therapy and Pathology, UMR 1222 INSERM, Institut Pasteur, Paris, France; DHU FIRE, Labex Inflamex, Université Paris Diderot Paris 7, Paris, France.
Department "Auto-immunité et Hypersensibilités," DMU BioGeM, APHP, Hôpital Bichat, Paris, France; "Inflammation, Microbiome and Immunosurveillance" INSERM UMR 996, Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, France.
J Allergy Clin Immunol. 2021 Apr;147(4):1133-1142. doi: 10.1016/j.jaci.2021.02.013.
Drug-induced anaphylaxis is a hyperacute reaction affecting multiple organs that can be of fatal consequence. Its incidence is increasing, consistent with a global increased sensitization to various allergens and drugs in the population. Few risk factors and mechanisms have been identified from human studies due to the rarity of anaphylactic events and their unpredictability. This systemic reaction is caused by the rapid release of a large range of functionally diverse mediators, including histamine and platelet-activating factor as the main drivers identified. Mechanisms defined from models of experimental anaphylaxis identify drug-specific antibodies of the IgE and IgG class that link the drug to antibody receptors on multiple cell types, causing their activation and mediator release. In the case of drugs with peculiar chemical structures, antibodies may not be necessary because drug-binding receptors, such as Mas-related G protein-coupled receptor member X2, have been identified. This review describes the complex reaction leading to drug-induced anaphylaxis that can involve various antibody classes, various cell types-including mast cells, neutrophils, platelets, basophils, macrophages, and monocytes-and their mediators and receptors that, importantly, can be activated alone or in association to participate in the severity of the reaction.
药物性过敏反应是一种影响多个器官的超急性反应，可能导致致命后果。随着人群对各种过敏原和药物的敏感性不断增加，其发病率也在不断上升。由于过敏反应事件的罕见性和不可预测性，从人体研究中仅确定了少数危险因素和机制。这种全身性反应是由大量功能不同的介质的快速释放引起的，包括组胺和血小板激活因子，它们是已确定的主要驱动因素。从实验性过敏反应模型中定义的机制确定了与药物结合的 IgE 和 IgG 类特异性抗体，这些抗体将药物与多种细胞类型上的抗体受体连接，导致其激活和介质释放。对于具有特殊化学结构的药物，可能不需要抗体，因为已经确定了药物结合受体，如 Mas 相关 G 蛋白偶联受体成员 X2。本文综述了导致药物性过敏反应的复杂反应，该反应可能涉及多种抗体类别、多种细胞类型，包括肥大细胞、中性粒细胞、血小板、嗜碱性粒细胞、巨噬细胞和单核细胞，以及它们的介质和受体，重要的是，这些介质和受体可以单独或联合激活，参与反应的严重程度。
