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　　原标题： 药物过敏的争议：体外检测
　　药物超敏反应(DHRs)虽然发率较低，但可能会很严重，并导致终生后遗症。诊断对于避免未来的过敏是至关重要的，并应确定致敏的药物和安全的替代品。然而，诊断是复杂和具有挑战性的。可靠的体外试验可提高DHR的诊断水平，并影响医学决策。重要的是，体外测试通常不是作为一项单独的测试而进行的，而是作为诊断方法的一部分，或附加的测试。不同内源性DHRs的体外治疗方法有多种。然而，只有很少的可用于常规诊断，而且许多仅限于研究实验室。体外试验显示出不同的敏感性和特异性，这取决于所涉及的药物和临床表型。体外试验可作为皮肤试验的补充，特别是对皮肤试验反应阴性或模棱两可、与临床表现不符的患者，以及不宜进行药物刺激试验的严重反应患者。许多诊断DHRs的体外试验存在的主要不足是未能在采用美国、欧盟及世界其它地区一致的标准对照进行的大规模的研究中进行验证。
　　延伸阅读
JACI：
Controversies in drug allergy: In vitro testing
https://doi.org/10.1016/j.jaci.2018.09.022
Despite their low frequency, drug hypersensitivity reactions (DHRs) can be serious and result in lifelong sequelae. The diagnosis is critical to avert future reactions and should identify the culprit drug or drugs and safe alternatives. However, making the diagnosis can be complex and challenging. Reliable in vitro tests can offer the potential to improve a diagnosis of DHR and influence medical decision making. Importantly, in vitro testing is frequently not performed as a test in isolation but rather as a component of a diagnostic algorithm along with additional tests. There are several in vitro approaches for the different endotypes of DHRs. However, only few are available for routine diagnosis, and many are restricted to research laboratories. In vitro tests exhibit varying sensitivity and specificity depending on the drug involved and the clinical phenotype. In vitro tests can complement skin tests, especially in patients with negative or equivocal skin test responses inconsistent with the clinical presentation and in severe reactions in which drug provocation tests are contraindicated. The main unmet need for many in vitro tests for the diagnosis of DHRs is validation in larger studies with standardized controls that could harmonize diagnostic management between the United States, European Union, and other regions of the world.
All Author:
CristobalinaMayorgaPhDab∗Didier G.EboMD, PhDcDavid M.LangMDdWerner J.PichlerMDeVitoSabatoMD, PhDcMiguel A.ParkMDfJoannaMakowskaMD, PhDgMarinaAtanaskovic-MarkovicMD, PhDhPatriziaBonadonnaMDiEdgardoJaresMDj∗
　　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。