原標(biāo)題： 藥物過敏的爭議：體外檢測
　　藥物超敏反應(yīng)(DHRs)雖然發(fā)率較低，但可能會很嚴重，并導(dǎo)致終生后遺癥。診斷對于避免未來的過敏是至關(guān)重要的，并應(yīng)確定致敏的藥物和安全的替代品。然而，診斷是復(fù)雜和具有挑戰(zhàn)性的?？煽康捏w外試驗可提高DHR的診斷水平，并影響醫(yī)學(xué)決策。重要的是，體外測試通常不是作為一項單獨的測試而進行的，而是作為診斷方法的一部分，或附加的測試。不同內(nèi)源性DHRs的體外治療方法有多種。然而，只有很少的可用于常規(guī)診斷，而且許多僅限于研究實驗室。體外試驗顯示出不同的敏感性和特異性，這取決于所涉及的藥物和臨床表型。體外試驗可作為皮膚試驗的補充，特別是對皮膚試驗反應(yīng)陰性或模棱兩可、與臨床表現(xiàn)不符的患者，以及不宜進行藥物刺激試驗的嚴重反應(yīng)患者。許多診斷DHRs的體外試驗存在的主要不足是未能在采用美國、歐盟及世界其它地區(qū)一致的標(biāo)準(zhǔn)對照進行的大規(guī)模的研究中進行驗證。
　　延伸閱讀
JACI：
Controversies in drug allergy: In vitro testing
https://doi.org/10.1016/j.jaci.2018.09.022
Despite their low frequency, drug hypersensitivity reactions (DHRs) can be serious and result in lifelong sequelae. The diagnosis is critical to avert future reactions and should identify the culprit drug or drugs and safe alternatives. However, making the diagnosis can be complex and challenging. Reliable in vitro tests can offer the potential to improve a diagnosis of DHR and influence medical decision making. Importantly, in vitro testing is frequently not performed as a test in isolation but rather as a component of a diagnostic algorithm along with additional tests. There are several in vitro approaches for the different endotypes of DHRs. However, only few are available for routine diagnosis, and many are restricted to research laboratories. In vitro tests exhibit varying sensitivity and specificity depending on the drug involved and the clinical phenotype. In vitro tests can complement skin tests, especially in patients with negative or equivocal skin test responses inconsistent with the clinical presentation and in severe reactions in which drug provocation tests are contraindicated. The main unmet need for many in vitro tests for the diagnosis of DHRs is validation in larger studies with standardized controls that could harmonize diagnostic management between the United States, European Union, and other regions of the world.
All Author:
CristobalinaMayorgaPhDab?Didier G.EboMD, PhDcDavid M.LangMDdWerner J.PichlerMDeVitoSabatoMD, PhDcMiguel A.ParkMDfJoannaMakowskaMD, PhDgMarinaAtanaskovic-MarkovicMD, PhDhPatriziaBonadonnaMDiEdgardoJaresMDj?
　　創(chuàng)建過敏性疾病的科研、科普知識交流平臺，為過敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺。