药物过敏的实验室检查

Laboratory Examination of Drug Allergy

药物过敏约占整个药物不良反应的5%～10%,是敏感个体对药物本身或者辅料产生的免疫学反应,是由免疫学机制介导的超敏反应。大多数药物过敏是由速发型或迟发型超敏反应引发。药物过敏的诊断主要包括在体诊断、体外诊断和药物激发试验。其中,药物点刺/皮内试验是临床上最常用的检测方法;药物特异性IgE检测是最常见的速发型药物过敏反应体外诊断方法;药物斑贴试验是诊断迟发型药物过敏反应的诊断方法;一些新的体外诊断方法包括嗜碱性粒细胞活化实验、药物特异性淋巴细胞增殖/活化试验、ELISA方法 /流式细胞技术/ELISpot方法检测药物诱导的相关细胞因子也显示出较高的特异性,但仍需大样本深入研究。药物过敏实验室诊断方法的敏感性并非100%,必要时仍需要药物激发试验。

Drug allergy accounts for approximately 5-10% adverse drug reactions. Drug allergy is defined as an immunologically mediated response to a pharmaceutical and / or formulation agent in a sensitized person. Most of drug allergies are IgE-mediated（ type Ⅰ） and cellular mediated（ type Ⅳ）. In diagnosis,prick / intradermal tests are the most readily available tools in clinics. Determination of specific Ig E levels is still the most common in vitro method for diagnosing immediate reactions. Drug patch test is the most valuable test for cellular mediated hypersensitivity in vivo. New diagnostic tools,such as the basophil activation test,the lymphocyte proliferation / activation test,and enzymelinked immunospot assays for analysis of the frequency of antigen specific,cytokineproducing cells,have been developed for evaluating either immediate or nonimmediate reactions. The sensitivities of above drug allergy diagnostic tests are not 100 %,provocation test is necessary in selected cases.