综述了有关嗜酸性粒细胞增多和全身症状(DRESS)的药物反应阳性斑贴试验结果的文献。在437名DRESS患者中发现了105种药物,它们共同导致536种阳性斑贴试验。到目前为止,大多数反应(n=145)是由卡马西平引起的,其次是阿莫西林,异烟肼,苯妥英,乙胺丁醇,Fluindione,苯巴比妥,利福平,和头孢曲松;43种药物每种仅引起一例。引起最多反应的药物类别是抗惊厥药(39%),β-内酰胺抗生素(20%),抗结核药(11%),非β-内酰胺类抗生素(6%),和碘化造影剂(5%)。对于抗惊厥药(尤其是卡马西平),斑贴测试(阳性反应的百分比)的敏感性很高,β-内酰胺抗生素(尤其是阿莫西林),and,可能,碘化造影剂.别嘌呤醇和柳氮磺胺吡啶经常引起DRESS,但从不给予阳性斑贴试验。DRESS中的补丁测试似乎是安全的,虽然有轻微的DRESS症状复发,主要是皮肤反应,可能并不罕见。16%的患者出现多种药物超敏反应,但有人认为真正的频率更高。DRESS的临床方面,包括诊断疾病和确定罪魁祸首药物(斑贴试验,皮内试验,体外试验,挑战测试)也提供,强调补丁测试的作用。
The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. One hundred and five drugs were identified that have together caused 536 positive patch tests in 437 DRESS patients. By far, the most reactions (n = 145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions were anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%), and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin), and, possibly, iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing.