Pichler W J
Institut für klinische Immunologie, Inselspital Bern.
Schweiz Med Wochenschr. 1993 Jun 12;123(23):1183-92.
Drug allergies can be subclassified into three subgroups, which differ in their pathophysiology and require different diagnostic steps: (1.) classical drug allergies, which are directed to the drug itself, a reactive compound of the drug, or some contamination of it; (2.) pseudo-allergic reactions, which are caused by non-immune mediated degranulation of mast cells and basophils, and (3.) autoimmune reactions, in which the drug elicits an immune reaction to autologous structures. A very detailed (criminalistic) history has the highest priority for clarification of a suspected drug allergy. In addition, skin tests, serological tests and the lymphocyte transformation test may be useful. It is necessary to differentiate between tests which imitate the drug elicited allergic reaction (i.e. Coombs test in drug induced hemolytic anemia) and tests which only indicate sensitization. The detection of IgG antibodies to drugs bound to various carriers (nitrocellulose, sepharose) is controversial and the meaning of a positive result is unclear. Therefore, this test cannot be recommended for the routine diagnosis of drug allergy. Special emphasis is placed on the value of the lymphocyte transformation test, which is more often positive than other test procedures and may sometimes strengthen the suspicion that a disease may be caused by a drug. Nevertheless, this test requires cautious interpretation as it may be falsely positive as well as falsely negative.
药物过敏可细分为三个亚组，它们在病理生理学方面存在差异，需要不同的诊断步骤：（1）经典药物过敏，针对药物本身、药物的反应性化合物或其某种污染物；（2）假过敏反应，由肥大细胞和嗜碱性粒细胞的非免疫介导脱颗粒引起；（3）自身免疫反应，其中药物引发对自身结构的免疫反应。对于疑似药物过敏的诊断，详尽的（类似刑侦的）病史最为重要。此外，皮肤试验、血清学试验和淋巴细胞转化试验可能有用。有必要区分模拟药物引发的过敏反应的试验（如药物诱导的溶血性贫血中的库姆斯试验）和仅表明致敏的试验。检测与各种载体（硝酸纤维素、琼脂糖）结合的药物的IgG抗体存在争议，阳性结果的意义尚不清楚。因此，不推荐将该试验用于药物过敏的常规诊断。特别强调淋巴细胞转化试验的价值，该试验比其他试验程序更常呈阳性，有时可能会加强对某种疾病可能由药物引起的怀疑。然而，该试验的解释需要谨慎，因为它可能出现假阳性和假阴性。
