Nuovi test diagnostici in vitro nell'allergia a farmaci

Adverse drug reactions (ADR) are a big problem in western countries, and this is mainly due to the increased use of drugs. Nevertheless, less than 15% of the ADRs are immunologically mediated and that IgE-mediated occur in a small percentage. The latter can be triggered also by low dosage of the drug, require a previous exposure to the same drug or to a chemically related drug and develop quickly after re-exposure. Pseudoallergic reactions to drugs, which may mimic that immunologically mediated, are due to direct release of histamine (opioids) or complement activation (radiocontrast media). They mainly occur after the intake of non-steroidal anti-inflammatory drugs and acetylsalicylic acid. A detailed pharmacological history, knowledge of the signs and symptoms associated with known immune mechanisms, are helpful in identifying the causative drug. Standardized in vitro tests for drug reactions are limited, since specific circulating IgE are detectable only in cases of beta-lactams and insulin allergy. This review focused on new in vitro diagnostic opportunities for ADRs and particularly on the recently developed methods of basophil activation test (sulphidoleukotrienes assay and cytofluorimetric analysis of CD63 after allergen stimulation) which are actually a highly specific laboratory tool to reveal both IgE and non IgE-mediated responses to drugs.