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　　原标题：药物过敏的争议：迟发反应测试
　　对于免疫介导的迟发性药物不良反应，如皮疹（广泛性斑丘疹）、嗜酸性粒细胞增多及系统性药物反应、急性全身性发疹性脓疱病、Stevens-Johnson综合征/中毒性表皮松解症、固定药疹等的体内途径存在争议。特别是, 在皮内和贴片测试的可用性和使用方面，各区域和实践之间存在着广泛的差异,使用的标准药物浓度, 为帮助确定交叉反应性，在皮内和贴片测试时使用的额外药物,有关药物不良反应发生的测试时间,测试在特定表型中的应用,以及使用口服挑战配合延迟的皮内和贴片测试来确定药物耐受性。值得注意的是，在东南亚的有关延迟T细胞介导反应的科学研究已经取得进展，在HLA-B*57:01和阿巴卡韦超敏反应、HLA-B*15:02和卡马西平Stevens-Johnson综合征/中毒性表皮坏死松解症的研究中，阐明了免疫病理机制并提供了一种处方前筛选机制。未来的方向应包括大型国际网络的合作，结合体内和体外实验室方法，开发和标准化体内诊断方法，如皮肤试验和贴片试验。


延伸阅读
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∗
　　创建过敏性疾病的科研、科普知识交流平台，为过敏患者提供专业诊断、治疗、预防的共享平台。