非IgE介導的藥物過敏的皮膚測試和斑貼試驗(附中文)

2018-12-21

藥物皮膚測試可以重現對藥物的延遲超敏反應,并導致患者適度地再次接觸有問題的藥物。


藥物斑貼試驗(DPTs)和點刺試驗可以用任何一種藥物的商業化形式進行。在非嚴重延遲非Ige介導的藥物反應中,有延遲讀數的皮內試驗(IDT)具有更大的價值,但其技術缺乏標準化。


藥物皮膚測試陰性并不排除藥物的責任,藥物必須在非嚴重的情況下重新檢測。


藥物斑貼試驗DPTs適用于黃斑丘疹、屈曲性疹,也適用于固定的藥疹。最好的適應癥是急性全身性膿皰病或伴有嗜酸性粒細胞增多和全身癥狀的藥物反應。他們應該謹慎地執行,遵循嚴格的指導方針。


點刺試驗的數值很低。在對藥物的非嚴重遲發反應中,皮內延遲讀數測試是最敏感的皮膚測試,尤其是-內酰胺類抗生素、放射對比劑、肝素以及一些生物制劑。

斑貼試驗檢測的價值因涉及藥物和非立即不良反應的不同而不同。在DRESS應用中,藥物斑貼試驗DPTs在卡馬西平或質子泵抑制劑的檢測中有很好的價值,但在別嘌呤醇或薩拉佐匹林的檢測中仍然為陰性。

在毒性表皮壞死松解術中,藥物斑貼試驗DPTs是安全的,但只有9%到23%的報告病例呈陽性。

Skin Testing and Patch Testing in Non-IgE-Mediated Drug Allergy

Authors

Authors and affiliations

First Online: 17 April 2014


Drug skin tests can reproduce delayed hypersensitivity to drugs and entail a moderate reexposure of patients to offending drugs. Drug patch tests (DPTs) and prick tests can be done with any commercialized form of a drug. In non-severe delayed non-IgE-mediated reactions to drugs, intradermal tests (IDT) with delayed readings have a greater value, but their techniques lack standardization. A negative drug skin test does not exclude the responsibility of a drug, and the drug must be rechallenged in non-severe cases. DPTs are useful in maculopapular rashes, flexural exanthemas, and if done in situ, also in fixed drug eruption. Their best indication is in acute generalized exanthematous pustulosis or drug reaction with eosinophilia and systemic symptoms (DRESS). They should be carried out cautiously, following strict guidelines. Prick tests have a low value but they can sometimes be positive on delayed readings. In non-severe delayed reactions to drugs, intradermal tests with delayed readings are the most sensitive skin tests especially for beta-lactam antibiotics, radiocontrast media, heparins but also some biological agents. The value of patch testing varies according to the implicated drug and the non-immediate adverse drug reaction. In DRESS, DPTs have a good value in testing carbamazepine or proton pump inhibitors but remain negative in testing with allopurinol or salazopyrin. In toxic epidermal necrolysis, DPTs are safe but positive in only 9 to 23 % of the reported cases.


国产精品免费一区二区三区视频,精品国产国偷自产在线观看,精品国产午夜福利在线观看蜜月,国产99视频精品免费播放