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    非IgE介导的药物过敏的皮肤测试和斑贴试验(附中文)
    时间:2018-12-21

    药物皮肤测试可以重现对药物的延迟超敏反应,并导致患者适度地再次接触有问题的药物。


    药物斑贴试验(DPTs)和点刺试验可以用任何一种药物的商业化形式进行。在非严重延迟非Ige介导的药物反应中,有延迟读数的皮内试验(IDT)具有更大的价值,但其技术缺乏标准化。


    药物皮肤测试阴性并不排除药物的责任,药物必须在非严重的情况下重新检测。


    药物斑贴试验DPTs适用于黄斑丘疹、屈曲性疹,也适用于固定的药疹。最好的适应症是急性全身性脓疱病或伴有嗜酸性粒细胞增多和全身症状的药物反应。他们应该谨慎地执行,遵循严格的指导方针。


    点刺试验的数值很低。在对药物的非严重迟发反应中,皮内延迟读数测试是最敏感的皮肤测试,尤其是-内酰胺类抗生素、放射对比剂、肝素以及一些生物制剂。

    斑贴试验检测的价值因涉及药物和非立即不良反应的不同而不同。在DRESS应用中,药物斑贴试验DPTs在卡马西平或质子泵抑制剂的检测中有很好的价值,但在别嘌呤醇或萨拉佐匹林的检测中仍然为阴性。

    在毒性表皮坏死松解术中,药物斑贴试验DPTs是安全的,但只有9%到23%的报告病例呈阳性。

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

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    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.


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