原標題：藥物過敏的爭議：遲發(fā)反應測試
　　對于免疫介導的遲發(fā)性藥物不良反應，如皮疹（廣泛性斑丘疹）、嗜酸性粒細胞增多及系統(tǒng)性藥物反應、急性全身性發(fā)疹性膿皰病、Stevens-Johnson綜合征/中毒性表皮松解癥、固定藥疹等的體內(nèi)途徑存在爭議。特別是, 在皮內(nèi)和貼片測試的可用性和使用方面，各區(qū)域和實踐之間存在著廣泛的差異,使用的標準藥物濃度, 為幫助確定交叉反應性，在皮內(nèi)和貼片測試時使用的額外藥物,有關藥物不良反應發(fā)生的測試時間,測試在特定表型中的應用,以及使用口服挑戰(zhàn)配合延遲的皮內(nèi)和貼片測試來確定藥物耐受性。值得注意的是，在東南亞的有關延遲T細胞介導反應的科學研究已經(jīng)取得進展，在HLA-B*57:01和阿巴卡韋超敏反應、HLA-B*15:02和卡馬西平Stevens-Johnson綜合征/中毒性表皮壞死松解癥的研究中，闡明了免疫病理機制并提供了一種處方前篩選機制。未來的方向應包括大型國際網(wǎng)絡的合作，結(jié)合體內(nèi)和體外實驗室方法，開發(fā)和標準化體內(nèi)診斷方法，如皮膚試驗和貼片試驗。


延伸閱讀
JACI：Volume 143, Issue 1, January 2019, Pages 66-73
Controversies in drug allergy: Testing for delayed reactions
https://doi.org/10.1016/j.jaci.2018.10.030
Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell–mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.
All Author:
ElizabethJ.PhillipsMDab?PaulBigliardiMDcAndreasJ.BircherMDdAnaBroylesMDeYoon-SeokChangMD,PhDfWen-HungChungMD,PhDgRannakoeLehloenyaMBChBhMajaMockenhauptMD,PhDiJonnyPeterMBChB,Mmed,PhDhMunirPirmohamedFRCP,PhDjJean-ClaudeRoujeauMDkNeilH.ShearMDlLucianaKaseTannoMD,PhDmnJasonTrubianoMBBS,PhDopRoccoValluzziMDqAnnickBarbaudMD, PhDrs?
　　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、預防的共享平臺。