Troost R J, Van Parys J A, Hooijkaas H, van Joost T, Benner R, Prens E P
Department of Immunology, Erasmus University, Rotterdam, The Netherlands.
Epilepsia. 1996 Nov;37(11):1093-9. doi: 10.1111/j.1528-1157.1996.tb01030.x.
Five to 20% of patients discontinue antiepileptic drug (AED) therapy because of adverse reactions. Careful reintroduction, however, may be considered if true drug allergy can be ruled out. Definitive assessment of such immunologically mediated reactions requires demonstration of either specific antibodies or sensitized lymphocytes.
We investigated whether skin patch tests (PTs) and in vitro lymphocyte proliferation assays (LPAs) were suitable for detection of allergy to carbamazepine (CBZ) and the possibly cross-reactive oxcarbazepine (OCBZ). Data of 65 patients displaying a wide range of possibly allergic side effects to CBZ were available for analysis. Data of CBZ users without any side effects and healthy volunteers served as controls. Both PTs and LPAs were done with CBZ, OCBZ and three metabolites [CBZ-10,11-epoxide (CBZ-E), 10-monohydroxy-CBZ (MHD), and 10,11-dihydroxy-CBZ (DIOL)].
Positive PTs with CBZ were seen in 20% and with OCBZ in 14% of the patients. Positive LPA results with CBZ and OCBZ, respectively, were found in 40 and 19%. Both tests were positive in 14 and 7% of the patients. Cross-reactivity to OCBZ was seen in -40% of CBZ-reactive patients in both PTs and LPAs.
These data illustrate the additional value of LPAs in the detection of CBZ allergy while showing that a major part of side effects to CBZ and OCBZ is not immunologically mediated, according to PTs and LPAs.
5%至20%的患者因不良反应而停用抗癫痫药物（AED）治疗。然而，如果可以排除真正的药物过敏，则可考虑谨慎重新用药。对这种免疫介导反应的明确评估需要证明存在特异性抗体或致敏淋巴细胞。
我们研究了皮肤斑贴试验（PT）和体外淋巴细胞增殖试验（LPA）是否适用于检测对卡马西平（CBZ）以及可能存在交叉反应的奥卡西平（OCBZ）的过敏反应。有65例对CBZ表现出广泛的可能过敏副作用的患者的数据可供分析。无任何副作用的CBZ使用者和健康志愿者的数据作为对照。PT和LPA均使用CBZ、OCBZ以及三种代谢物[CBZ - 10,11 - 环氧化物（CBZ - E）、10 - 单羟基 - CBZ（MHD）和10,11 - 二羟基 - CBZ（DIOL）]进行。
20%的患者对CBZ斑贴试验呈阳性，14%的患者对OCBZ斑贴试验呈阳性。对CBZ和OCBZ的LPA结果分别有40%和19%呈阳性。两项试验均呈阳性的患者分别为14%和7%。在PT和LPA中，40%对CBZ反应的患者对OCBZ存在交叉反应。
这些数据说明了LPA在检测CBZ过敏方面的附加价值，同时表明根据PT和LPA，CBZ和OCBZ的大部分副作用并非免疫介导。
