Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Ann Allergy Asthma Immunol. 2023 Feb;130(2):161-168. doi: 10.1016/j.anai.2022.10.006. Epub 2022 Oct 12.
Despite the significant negative impact drug allergies can have on patient care, the diagnosis is largely based on clinical history, and there are limited diagnostic tests that can be done at the time of a reaction. Biomarkers are needed to improve the diagnosis and the identification of the culprit medication. Skin testing is the most useful biomarker for immediate- and delayed-type reactions available, but it is limited by its low sensitivity. To improve its accuracy and reproducibility, a standardized procedure must be used. For immediate-type reactions, penicillin skin testing is the most widely studied, and it can be used in patients with history of anaphylaxis or recent immunoglobulin E-mediated reaction or for whom there is a significant risk if a reaction were to occur, such as pregnancy. Skin testing is also important in allergy to platinum agents allowing for continued first-line therapy. For delayed-type reactions, patch testing and delayed intradermal testing, used in conjunction with clinical history, can help to improve identification of the culprit medication depending on the type of reaction. Other biomarkers including in vitro testing for specific immunoglobulin E, basophil activation test, lymphocyte transformation test, ELISpot, and genetic factors that increase the likelihood of reaction are under investigation, and they may be most helpful when used in combination with the clinical history and skin testing results.
尽管药物过敏会对患者治疗产生重大负面影响，但目前的诊断主要基于临床病史，而且在发生过敏反应时，可进行的诊断检测非常有限。我们需要生物标志物来改善诊断和确定元凶药物。皮肤试验是目前可用于速发型和迟发型反应的最有用的生物标志物，但它的灵敏度有限。为了提高其准确性和可重复性，必须使用标准化程序。对于速发型反应，青霉素皮肤试验是研究最广泛的，可用于有过敏史、近期免疫球蛋白 E 介导反应或如果发生反应风险显著的患者，如妊娠。皮肤试验对于铂类药物过敏也很重要，可允许继续一线治疗。对于迟发型反应，斑贴试验和迟发型皮内试验与临床病史一起使用，可以根据反应类型帮助提高确定元凶药物的能力。其他生物标志物包括针对特定免疫球蛋白 E 的体外检测、嗜碱性粒细胞激活试验、淋巴细胞转化试验、ELISpot 和增加发生反应可能性的遗传因素，当与临床病史和皮肤试验结果结合使用时，它们可能最有帮助。
