Testes in vivo nas reações de hipersensibilidade a medicamentos - Parte II: testes de provocação
In vivo tests in hypersensitivity drug reactions - Part II: provocation tests
Marcelo Vivolo Aun; Maria Fernanda Malaman; Mara Morelo Rocha Felix; Ullissis Pádua Menezes; Gladys Queiroz; Adriana Teixeira Rodrigues; Carolina Sanchez Aranda; Inês Cristina Camelo-Nunes; Dirceu Solé; Norma de Paula M. Rubini
Resumo
O diagnóstico das reações de hipersensibilidade a medicamentos é baseado na história clÃnica, seguida pela realização de testes in vivo, que podem ser cutâneos ou de provocação. Os testes de provocação são considerados o padrão-ouro no diagnóstico, sendo importantes tanto para a confirmação diagnóstica como para o encontro de opções terapêuticas seguras. Recentemente, assim como os testes cutâneos, as provocações com medicamentos foram aprovadas pela Câmara Técnica da Associação Médica Brasileira para uso no diagnóstico das reações a drogas. Nesta revisão, nosso foco serão as indicações, contraindicações e método dos testes de provocação com medicamentos.
Palavras-chave
Abstract
Diagnosis of hypersensitivity drug reactions is based on clinical history, followed by in vivo tests, such as skin tests and drug provocation tests. Drug provocation tests are considered the gold standard for diagnosis. They are important both for confirming diagnosis and for finding safe therapeutic options. As for skin tests, provocation tests were recently approved by the Brazilian Medical Association Technical Board to be used in hypersensitivity drug diagnosis. In this review paper, we will focus on indications, contraindications and method of drug provocation tests.
Keywords
Referências
1. Gruchalla RS. Drug Allergy. J Allergy Clin Immunol. 2003;S548‑59.
2. Greenberger PA. Drug Allergy. J Allergy Clin Immunol. 2006;S464‑70.
3. Demoly P, Adkinson, Brockow K, Castells M, Chiriac AM, Greenberger PA, et al. International Consensus on drug allergy. Allergy. 2014;69:420-37.
4. Gomes E, Cardoso MF, Praca F, Gomes L, Marino E, Demoly P. Self-reported drug allergy in a general adult Portuguese population. Clin Exp Allergy. 2004;34:1597-601.
5. Macy E. Penicillin and beta-lactam allergy: epidemiology and diagnosis. Curr Allergy Asthma Rep. 2014;14(11):476.
6. Aun MV, Malaman MF, Felix MMR, Menezes UP, Queiroz GRS, Rodrigues AT, et al. Testes in vivo nas reações de hipersensibilidade a medicamentos - Parte I: testes cutâneos. Arq Asma Alerg Imunol. 2018;2(4):390-8.
7. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003;58:854-63.
8. Trautmann A, Goebeler M, Stoevesandt J. Twenty years' experience with anaphylaxis-like reactions to local anesthetics: genuine allergy is rare. J Allergy Clin Immunol Pract. 2018;6(6):2051-8.
9. Berkum Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience in 236 patients. Ann Allergy Asthma Immunol. 2003;91:342-5.
10. Helmut G, Kaufmann R, Kalveram CM. Adverse reactions to local anesthetics: analysis of 197 cases. J Allergy Clin Immunol. 1996;97:933-7.
11. Soyer O, Sahiner UM, Sekerel BE. Pro and contra: provocation tests in drug hypersensitivity. Int J Mol Sci. 2017;18(7):1437.
12. Aun MV, Bisaccioni C, Garro LS, Rodrigues AT, Tanno LK, Ensina LF, et al. Outcomes and safety of drug provocation tests. Allergy Asthma Proc. 2011;32:301-6.
13. Iammatteo M, Ferastraoaru D, Koransky R, Alvarez-Arango S, Thota N, Akenroye A, et al. Identifying allergic drug reactions through placebo-controlled graded challenges. J Allergy Clin Immunol Pract. 2017;5:711-7.
14. Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, et al. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy. 2016;71:149-61.
15. Lezmi G, Alrowaishdi F, Bados-Albiero A, Scheinmann P, de Blic J, Ponvert C. Non-immediate-reading skin tests and prolonged challenges in non-immediate hypersensitivity to beta-lactams in children. Pediatr Allergy Immunol. 2018;29:84-9.
16. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of Penicillin Allergy: a review. JAMA. 2019;321(2):188‑99.
Submetido em:
18/02/2019
Aceito em:
27/02/2019
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