Zent C
Department of Pharmacology, University of Cape Town.
S Afr Med J. 1994 May;84(5):281-6.
Drug allergy is an important complication in the use of agents such as penicillins, cephalosporins, sulphonamides, insulin and streptokinase. The allergenic properties of drugs are a function of molecular size and chemical reactivity. Factors determining an individual's risk of an allergic response are not fully understood but include genetic predisposition, prior exposure, route of administration, drug dosage, age and concomitant disease. The most dangerous but least common form of drug allergy is generalised anaphylaxis. The majority of reactions are non-anaphylactic and involve the skin, with a lesser incidence of haematological, renal, musculoskeletal, cardiorespiratory and other systemic manifestations. The only definitive test for allergy in a patient with a history of previous allergic reaction is rechallenge, a dangerous and seldom indicated procedure. An alternative is skin testing, but this requires an experienced practitioner and has intrinsic risk. In vitro testing may be of value in predicting the risk of rechallenge. Safe use of a suspect drug requires a careful assessment of risk and a cautious approach. Use of an offending drug in a high-risk patient is rarely indicated, but if it is considered essential, initial therapy or desensitisation in an intensive care environment is recommended.
药物过敏是使用青霉素、头孢菌素、磺胺类药物、胰岛素和链激酶等药物时的一种重要并发症。药物的致敏特性是分子大小和化学反应性的函数。决定个体发生过敏反应风险的因素尚未完全明确，但包括遗传易感性、既往接触史、给药途径、药物剂量、年龄和伴随疾病。药物过敏最危险但最不常见的形式是全身性过敏反应。大多数反应是非过敏性的，累及皮肤，血液学、肾脏、肌肉骨骼、心肺和其他全身表现的发生率较低。对于有既往过敏反应史的患者，唯一确定过敏的试验是再次激发试验，这是一种危险且很少进行的操作。另一种方法是皮肤试验，但这需要经验丰富的从业者，且存在固有风险。体外试验在预测再次激发试验的风险方面可能有价值。安全使用可疑药物需要仔细评估风险并采取谨慎的方法。在高危患者中很少使用引起过敏的药物，但如果认为有必要，建议在重症监护环境中进行初始治疗或脱敏治疗。
