약물 알레르기의 진단 - ekjm.org

1 : 76 3 2009- 282 - (Special Review) - Update on the diagnosis of drug allergyYoung Joo Cho, of Medicine, Division of Allergy and Clinical Immunology, Ewha Womans University School of Medicine, Seoul, KoreaHypersensitivity reactions to drugs are classified as immediate or nonimmediate reactions depending on the basis of time of appearance of reactions. Clinical and immunological studies suggest that immediate reaction is IgE-mediated and nonimmediate as type-IV (cell-mediated) reaction.

2 For the evaluation of drug allergy, the patient's history is fundamental; the allergologic examination includes in-vivo and in-vitro tests selected on the basis of the clinical features. Prick, patch, and intradermal tests are the most readily available forms of allergy testing. However, there are some changes in the diagnostic evaluation of allergic reactions to beta-lactams, iodinated contrast media and local anaesthetics over the last several years. In immediate reactions, the sensitivity of skin testing and immunoassay is decreasing and for nonimmediatedreactions, skin testing appears to be less sensitive than previous results.

3 Drug provocation test is still the gold standard for identification of an causative drugs. The new diagnostic tools, such as the basophil activation test and the lymphocyte activation test, have been developed and are under validation. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and immediate drug review provides an update to European Network for Drug Allergy (ENDA) document that gave the guidelines for the evaluation of drug allergy. The diagnosis of drug allergy needs to be standardized.

4 (Korean J Med 76:282-290, 2009) Ke y Words: Drug Allergy; Immediate reaction; Nonimmediate reaction; Skin test . , , . IgE T ( ) 1). 1 , , , , (maculopapular), / , , exfoliative dermatitis, acute generalized exant-hemattous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) Stevens- Johnson syndrome, toxic epidermal necrolysis (TEN) 2).

5 , . , , 3). European Network for Drug Young Joo Cho. Update on the diagnosis of drug allergy - 283 -Type of reactionType of testImmediateNonimmediateIn vitroIn vivoIn vitroIn vivoSpecific IgE assaysFlow cytometric basophil activation testsSkin testsDrug provocation testsLymphocyte transformatior or activation testsDelayed-reading intradermal tests patch testsDrug provocation testFrom Romano A, Demoly P:Recent advances in the dia-gnosis of drug allergy.

6 Cur Opinion Allergy and Clinic Immunol. 7, 299-303, 2007 Table 1. Diagnostic tests of hypersensitivity reactions to drugsAllergy (ENDA) 2009 standard operating procedures (SOPs) 4). , .. IgE T ENDA . , .. ENDA 1999 5). ( 1)6).

7 , 7).1 : a. b. c. , d. , , (ESR, , tryptase, proteinuria ) 2 : .a. , b. 3 : 4 : 5 : IgE , 14 haptenic .6 : , IgE IgE ENDA IgE 1, 2 6).

8 1 , , 2 2 .1.. Beta lactams(BLs) 8-10), penicillin 2 7). cephalosporins, , , 6). BLs : 76 3 583 2009 - 284 -Prior reactionPenicillin skin testsIgE-dependent reaction (%)Any immunologic reaction (%)AnyAll historiesAnaphylaxisUrticariaExanthemOth er/unknownNone PositiveNegative PositiveNegative50 80* <50 *Limited data from inadvertent treatment or provocational challenge Data from large, outpatient, sexually transmitted disease clinical study.

9 Data unavailable for major and minor determinant testing. Early studies with penicilloyl polylysine in history-negative subjects indicated a low reaction rate ( ).From Middleton's Allergy: Principles and Practice, 7th Edition Table 2. Predictive value of penicillin skin testingFigure 1. Short algorithm for the diagnosis of immediate allergicreactions to betalactams. From Blanca M, Romano A, Torres MJ, et al. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy. 64:183-193, 2009 Figure 2.

10 Long algorithm for the diagnosis of immediate allergicreactions to betalactams. From Blanca M, Romano A, Torres MJ, et al. Update on the evaluation of hypersensitivity reactionsto betalactams. Allergy. 64:183-193, 2009 . BLs carbonyl group benzylpenicilloyl determinant (BPO) 12). BLs Benzylpenicillin (BP), amoxacillin (AX) cephalosporins . side chain . ENDA , . , major, minor BP detre-minants , in vitro.