药物激发试验在药物超敏反应诊断中的应用

Drug provocation tests in the diagnosis of drug hypersensitivity reactions

药物激发试验是确诊和除外药物过敏诊断的金标准，也是提供可替代药物安全有效的方法。国际上药物激发试验的操作方法尚未统一，目前的共识认为，在常规单日口服激发的基础上，使用长时程连续激发可以提高诊断的阳性率。药物激发试验的阴性预测值高达90%以上，其安全性也很高，即使是儿童的长时程连续激发，阳性反应几乎均为出疹或荨麻疹/血管性水肿，反应轻、易控制。诸多关于其诊断价值、安全性和患者接受度的研究结果提示可以进一步开展研究，以期获得更安全和准确的操作方法。

Drug provocation tests （DPTs） are considered to be not only a gold standard for the diagnosis and exclusion of drug hypersensitivity, but also a safe and efficient approach to seeking alternative medicines. The operation procedures for DPTs have not yet been internationally unified. At present, consensus has been reached that prolonged successive provocation in addition to routine daily oral provocation can improve the positive rate of DPTs. DPTs have a high negative predictive value of more than 90%, and are fairly safe. Almost all positive reactions to DPTs, even long-term DPTs in children, manifest as skin eruptions or urticaria/angioedema, which are mild and easily controlled. Many studies on the diagnostic value, safety and acceptance of SPTs among patients indicate that further researches are required to develop safer and more accurate operation procedures.