Laboratory diagnosis drug allergy. Part 1. Methodology for determining the specific immunoglobulins to drugs, mediators and cytokines

Abstract

Allergic inflammation of the skin is the basis of drug allergies, mucous membranes and other tissues and organs damage, it is due to the synthesis of immune factors in the body that can interact with drugs or their metabolites. The vast majority of allergic reactions is registered on antibiotics, local analgetics, nonsteroidal antiinflammatory drugs, heterologous serums, radiopaque agents, protein drugs of human blood, vaccines, enzymes, vitamins, tranquilizers, antidiabetic preparations, psychoactive preparations, ACE inhibitors, antiarrhythmic drugs. However any medicinal substance can cause drug allergy. The indications for laboratory examination of patients with drug intolerance are: anaphylactic shock, severe toxikodermia in anamnesis of an unknown drug and the need for drug therapy, significant lesions of the skin and the need of a medication; during using of glucocorticoids, antihistamines, necessary the introduction of potentially harmful drugs, in the early childhood, a high level of sensitization of patients, continuously relapsing course of disease; polyvalent sensitization, where there is no possibility of testing in vivo directly with all potential allergens in a limited period of examination; dramatically altered reactivity of the skin; false-positive or false-negative result in skin testing, urticaria autographism. In order to identify immediate hypersensitivity use the following in vitro tests: determination of the activity of tryptase in the serum in order to determine the presence of mast cell degranulation, the definition of the concentration of specific IgE in serum, holding basophil activation test in the presence of a potential allergen.