原標(biāo)題：藥物過(guò)敏的爭(zhēng)議：遲發(fā)反應(yīng)測(cè)試
　　對(duì)于免疫介導(dǎo)的遲發(fā)性藥物不良反應(yīng)，如皮疹（廣泛性斑丘疹）、嗜酸性粒細(xì)胞增多及系統(tǒng)性藥物反應(yīng)、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(zhēng)議。特別是, 在皮內(nèi)和貼片測(cè)試的可用性和使用方面，各區(qū)域和實(shí)踐之間存在著廣泛的差異,使用的標(biāo)準(zhǔn)藥物濃度, 為幫助確定交叉反應(yīng)性，在皮內(nèi)和貼片測(cè)試時(shí)使用的額外藥物,有關(guān)藥物不良反應(yīng)發(fā)生的測(cè)試時(shí)間,測(cè)試在特定表型中的應(yīng)用,以及使用口服挑戰(zhàn)配合延遲的皮內(nèi)和貼片測(cè)試來(lái)確定藥物耐受性。值得注意的是，在東南亞的有關(guān)延遲T細(xì)胞介導(dǎo)反應(yīng)的科學(xué)研究已經(jīng)取得進(jìn)展，在HLA-B*57:01和阿巴卡韋超敏反應(yīng)、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(jī)制并提供了一種處方前篩選機(jī)制。未來(lái)的方向應(yīng)包括大型國(guó)際網(wǎng)絡(luò)的合作，結(jié)合體內(nèi)和體外實(shí)驗(yàn)室方法，開(kāi)發(fā)和標(biāo)準(zhǔn)化體內(nèi)診斷方法，如皮膚試驗(yàn)和貼片試驗(yàn)。


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(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過(guò)敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。