Elst Jessy, Mertens Christel, Van Houdt Michel, van der Poorten Marie-Line M, Van Gasse Athina L, Toscano Alessandro, Beyens Michiel, Yerly Daniel, Hagendorens Margo M, Sabato Vito, Hausmann Oliver, Ebo Didier G
Department of Immunology, Allergology and Rheumatology and the Infla-Med Centre of Excellence, University Antwerp, Antwerp University Hospital, Antwerpen, Belgium.
Department of Paediatrics and the Infla-Med Centre of Excellence, University Antwerp, Antwerp University Hospital, Antwerpen, Belgium.
Allergy. 2025 May;80(5):1242-1255. doi: 10.1111/all.16548. Epub 2025 Apr 3.
Immediate drug hypersensitivity reactions (IDHRs) pose significant diagnostic challenges, often requiring potentially hazardous drug challenge testing (DCT). Flow cytometry-based cellular tests including the basophil activation test (BAT), the mast cell activation test (MAT) and the T cell activation test (TAT) offer promising alternatives to reduce DCT reliance. While these tests are still in development, they demonstrate potential to compete with skin tests by providing superior diagnostic performance and improved patient safety by reducing the need for DCT. Furthermore, it is encouraging that these flow cytometry-based tests are also suitable for challenging populations, such as children. Despite requiring specialised infrastructure, these tests have the potential to be cost-effective when performed in reference centres and may offer unique mechanistic insights into immediate drug hypersensitivity reactions. However, further research is needed to validate their reliability, address pharmaceutical-specific testing considerations, and potentially integrate them into clinical guidelines.
速发型药物过敏反应（IDHRs）带来了重大的诊断挑战，通常需要进行具有潜在危险性的药物激发试验（DCT）。基于流式细胞术的细胞检测，包括嗜碱性粒细胞活化试验（BAT）、肥大细胞活化试验（MAT）和T细胞活化试验（TAT），为减少对DCT的依赖提供了有前景的替代方法。虽然这些检测仍在研发中，但它们通过提供卓越的诊断性能以及通过减少对DCT的需求来提高患者安全性，显示出与皮肤试验竞争的潜力。此外，令人鼓舞的是，这些基于流式细胞术的检测也适用于具有挑战性的人群，如儿童。尽管需要专门的基础设施，但这些检测在参考中心进行时有可能具有成本效益，并且可能为速发型药物过敏反应提供独特的机制见解。然而，需要进一步研究来验证其可靠性，解决特定药物检测的考虑因素，并有可能将它们纳入临床指南。
