Houwerzijl J, De Gast G C, Nater J P, Esselink M T, Nieweg H O
Clin Exp Immunol. 1977 Aug;29(2):272-7.
Seven cases of severe hypersensitivity to carbamazepine (Tegretol) were described in patients with epilepsy or trigeminal neuralgia. Clinical manifestations consisted of fever, rash, facial oedema, lymphadenopathy, impaired liver function, eosinophilia and atypical lymphocytes in the peripheral blood. Lymphocyte-stimulation tests with carbamazepine in vitro showed positive results in all cases; patch tests with carbamazepine were positive in six cases. In two cases the lymphocyte-stimulation tests with carbamazepine were found to be negative during, and shortly after, the illness. However, when the tests were repeated several months later, they turned out to be positive. Lymphocyte reactivity to PPD and PHA in vitro was also impaired during the acute phase of the disease. Thus false-negative lymphocyte-stimulation tests may be found in the first months following such a hypersensitivity reaction, probably due to impaired lymphocyte reactivity. As carbamazepine is a potent drug and is often prescribed for long periods together with other anticonvulsants, it seems important to prove that the allergic reaction is caused by carbamazepine. If the lymphocyte-stimulation test in vitro or the patch test with carbamazepine is found to be negative during or shortly after the illness, they should be repeated several months later.
本文描述了7例癫痫或三叉神经痛患者对卡马西平（得理多）严重过敏的病例。临床表现包括发热、皮疹、面部水肿、淋巴结病、肝功能损害、嗜酸性粒细胞增多以及外周血中出现非典型淋巴细胞。卡马西平体外淋巴细胞刺激试验在所有病例中均呈阳性；卡马西平斑贴试验6例呈阳性。2例患者在患病期间及患病后不久，卡马西平淋巴细胞刺激试验结果为阴性。然而，数月后重复试验时，结果转为阳性。疾病急性期体外淋巴细胞对结核菌素纯蛋白衍生物（PPD）和植物血凝素（PHA）的反应性也受损。因此，在这种过敏反应后的最初几个月可能会出现假阴性的淋巴细胞刺激试验，这可能是由于淋巴细胞反应性受损所致。由于卡马西平是一种强效药物，常与其他抗惊厥药长期联合使用，因此证实过敏反应由卡马西平引起似乎很重要。如果在患病期间或患病后不久卡马西平体外淋巴细胞刺激试验或斑贴试验结果为阴性，应在数月后重复进行。
