Patch Testing in Non-Immediate Drug Eruptions 英文参考文献.docVIP

ORIGINAL ARTICLE PatchTestinginNon-ImmediateDrugEruptions AntoninoRomano,MD,MarinellaViola,MD,FrancescoGaeta,MD,GabrieleRumi,MD,and MichelaMaggioletti,MD Thepresentreviewaddressestheliteratureregardingthesensitivityandspecificityofthevariousdiagnosticmethodsforevaluating non-immediate(ie,occurringmorethan1hourafterdrugadministration)hypersensitivityreactionsassociatedwithb-lactamsand other antibiotics, anticonvulsants, heparins, iodinated contrast media, etc. Such reactions include several clinical entities, which rangefrommildreactions,suchasmaculopapularrashanddelayed-appearingurticaria,tosevereones,suchasacutegeneralized exanthematouspustulosis(AGEP),Stevens-Johnsonsyndrome,andtoxicepidermalnecrolysis(TEN).Clinicalandlaboratorystudies indicatethatacell-mediatedpathogenicmechanismisofteninvolvedinmaculopapularrashes.However,thismechanismhasalso been demonstrated in other non-immediate reactions, such as urticarial and/or angioedematous manifestations, TEN, bullous exanthems, and AGEP. Patch tests, together with delayed-reading intradermal tests, lymphocyte transformation tests, and challenges,areusefultoolsforevaluatingnon-immediatedrugeruptions.Patchtestscanbeperformedwithanyformofcommercial drugsandaresaferthanintradermaltests.However,patchtestsarelesssensitivethanintradermaltests,andtheirsensitivitymay vary,dependingonthevehicleused. Keywords: delayed-readingintradermaltests,non-immediatereactions,patchtests I n recent years, increasing attention has been paid to non-immediate (ie, occurring more than 1 hour after medClinicaliated paandthoglaboratoryenic mechastudiesnism isindicateoften ithatnvolvaedcell-in drug administration)1 hypersensitivity reactions to sys- temically administered drugs. The main non-immediate reactionsaremaculopapular rashesanddelayed-appearing urticaria. In addition, drugs can elicit exfoliative derma- titis, acute generalized exanthematous pustulosis (AGEP), more severe bullous exanthems such as Stevens-Johnson syndrome (SJS), and t