Drug Allergies

Year 2009, Volume: 7 Issue: 3, 76 - 82, 01.12.2009

Mehtap Kılıç Fadıl Öztürk

Abstract

Adverse drug reactions are common, but only 15% are immunologically mediated. As drug use continues to increase, the incidence of drug allergy willalso continue to rise. Drug allergies have a significant impact on clinicalpractice, drug development and public health. One of the significant consequences of allergic drug reactions is causing the use of potentially less effective,more expensive or more toxic drugs in the future. The symptoms may be lifethreatening. The diagnosis of drug allergies relies on clinical histories, skintests and a very few validated in-vitro tests. Education of the patient and primary care physician is an important component of management. This article reviews the current understanding in the mechanisms and recognizingmethods of drug allergy and the management of patients

Keywords

Drug allergy, pathogenesis, diagnosis, management

İlaç Alerjileri

Abstract

İstenmeyen ilaç reaksiyonları oldukça sık görüldüğü halde sadece %15 kadarıimmünolojik mekanizmalarla oluşur. İlaç kullanımı artmaya devam ettikçe ilaçalerjisi insidansı da artmaya devam edecektir. İlaç alerjileri klinik uygulama,ilaç geliştirilmesi ve halk sağlığı açısından önemli etkiye sahiptir. Alerjik ilaçreaksiyonlarının önemli sonuçlarından biri olasılıkla daha az etkili, daha pahalıveya daha toksik ilaçların kullanımına neden olmasıdır. Belirtiler yaşamı tehditedebilir. İlaç alerjilerinin tanısı klinik öykü, deri testleri ve onaylanmış birkaç invitro teste dayanır. Hasta ve hekimin eğitimi tedavinin önemli bir parçasıdır. Bumakale ilaç alerjilerinin yeni anlaşılmış mekanizmalarını, tanı yöntemlerini vehasta tedavisini gözden geçirmektedir

Keywords

İlaç alerjisi, patogenez, tanı, yaklaşım

References

• 1. World Health Organization. International drug monitoring: the role of the hospital. Geneva: The Organization, 1966.
• 2. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 2004;113:832-6.
• 3. Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol 2005; 5:309-16.
• 4. Orhan F, Karakas T, Cakir M, Akkol N, Bahat E, Sonmez FM, Gedik Y. Parental-reported drug allergy in 6-to 9-yrold urban school children. Pediatr Allergy Immunol 2008;19:82-5.
• 5. Thong BY, Leong KP, Tang CY, Chng HH. Drug allergy in a general hospital: Results of a novel prospective inpatient reporting system. Ann Allergy Asthma Immunol 2003;90:342-7.
• 6. Michael E, Weiss MD. Recognising drug Allergy. Mostgraduate Medicine. Minneapolis 2005;117: 32.
• 7. Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 2008;178:1563-9.
• 8. Pumphrey R. Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol 2004;4:285-90.
• 9. Thong BY, Leong KP, Tang CY, Chng HH. Drug allergy in a general hospital: Results of a novel prospective inpatient reporting system. Ann Allergy Asthma Immunol 2003;90:342-7.
• 10. Gruchalla RS. Drug metabolism, danger signals, and drug-induced hypersensitivity. J Allergy Clin Immunol 2001;108:475-88.
• 11. Rawlins MD, Thompson JW. Pathogenesis of adverse drug reactions. In: Davies DM (ed). Textbook of adverse drug reactions. Oxford: Oxford University Press, 1977:10.
• 12. Adkinson NF. Drug allergy. In: Middleton E, Reed C, Ellis FE (eds.) Allergy , Principle and Practise. 5th edition. St. Louis: Mosby; 1998. p.1212-24.
• 13. Attaway NJ, Jasin HM, Sullivan TJ. Familial drug allergy. J Allergy Clin Immunol 1991;87:227.
• 14. Chung WH, Hung SI, Chen YT. Human leukocyte antigens and drug hypersensitivity. Curr Opin Allergy Clin Immunol 2007;7:317-23.
• 15. Adkinson NF Jr, Essayan D, Gruchalla R, Haggerty H, Kawabata T, Sandler JD, et al. Task force report: future research needs for the prevention and management of immune-mediated drug hypersensitivity reactions. J Allergy Clin Immunol 2002;109:461-78.
• 16. Haddi E, Charpin D, Tafforeau M, Kulling G, Lanteaume A, Kleisbauer JP, Vervloet D. Atopy and systemic reactions to drugs. Allergy 1990;45:236-9.
• 17. Posadas SJ, Pichler WJ. Delayed drug hypersensitivity reactions-new concepts. Clin Exp Allergy 2007;37:989-99.
• 18. Sanderson JP, Naisbitt DJ, Park BK. Role of bioactivation in drug-induced hypersensitivity reactions. AAPS J 2006; 8:55-64.
• 19. Pirmohamed M, Madden S, Park BK. Idiosyncratic drug reactions. Metabolic bioactivation as a pathogenic mechanism. Clin Pharmacokinet 1996;31:215-30.
• 20. Coombs PR, Gell PG. Classification of allergic reactions responsible for clinical hypersensitivity and disease. In: Gell PR (ed). Clinical aspects of immunology. Oxford: Oxford University Pres; 1968. p.575-96.
• 21. Pichler WJ. Delayed drug hypersensitivity drug reactions. Ann Intern Med 2003;139:683-93.
• 22. Pichler WJ, Zanni M, von Greyerz S. High IL5 production by drug specific T-cell clones. Int Arch Appl Allergy Immunul 1997;113:117-80.
• 23. Kudva Patel V, White E, Karnani E, Collins MH, Assa’ad AH. Drug reaction to ceftriaksone in a child with X-linked agammaglobulinemia. J Allergy Clin Immunol 2002;109:888-9.
• 24. MC Carroll, KA Yueng-Yue, NB Esterly, BA Drolet. Drug-Induced Hypersensitivity Syndrome in Pediatric Patients. Pediatrics 2001;108:485-492.
• 25. International Rheumatic Fever Study Grup. Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. Lancet 1991;337:1308-10.
• 26. Demoly P, Lebel B, Messaad D, Sahla H, Rongier M, Daurès JP. Predictive capacity of histamine release for the diagnosis of drug allergy. Allergy 1999;54:500-6.
• 27. Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Drug allergy claims in children: from self-reporting to confirmed diagnosis. Clin Exp Allergy 2008;38:191-8.
• 28. Warrington R. The truth about drug allergies. The Canadian Journal of CME 2002;188-93.
• 29. Demoly P, Kropf R, Bircher A, Pichler WJ. Drug hypersensitivity: questionnaire. EAACI interest group on drug hypersensitivity. Allergy 1999;54:999-1003.
• 30. Demoly P, Bousquet J. Drug allergy diagnosis work up. Allergy 2002;57 Suppl 72:37-40.
• 31. Weiss ME, Adkinson NF. Diagnostic test for drug hypersensitivity. In: Tilles SA (ed). Drug hypersensitivity. Immunol and Allergy Clin North Am. Philadelphia: WB Saunders Company, 1998;18:731-44.
• 32. Torres MJ, Blanca M, Fernandez J, Romano A, Weck A, Aberer W, et al. Diagnosis of immediate reactions to betalactam antibiotics. Allergy 2003;58:961-72.
• 33. Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy 2002;57:45-51.
• 34. Romano A, Demoly P. Recent advances in the diagnosis of drug allergy. Curr Opin Allergy Clin Immunol 2007;7:299-303.
• 35. Bavbek S. ‹laç allerjilerinde in vitro tan›sal testler. In: Bavbek S, M›s›rl›gil Z (eds). ‹laç Alerjileri. Ankara: Bilimsel T›p Yay›nevi; 2005. p.65-84.
• 36. Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am 2006;26: 51-63.
• 37. de Weck AL, Sanz ML, Gamboa PM, Aberer W, Bienvenu J, Blanca M, Demoly P, Ebo DG, Mayorga L, Monneret G, Sainte-Laudy J. Diagnostic tests based on human basophils: more potentials and perspectives than pitfalls. Int Arch Allergy Immunol 2008;146:177-89.
• 38. Sanz ML, Gamboa PM, De Weck AL. Cellular tests in the diagnosis of drug hypersensitivity. Curr Pharm Des 2008;14:803-8.
• 39. Saito M, Yagi M, Uno K, Takanaka K. Comparative study of the usefulness of the drug-induced lymphocyte stimulation test and the leukocyte migration test in drug allergies. Biol Pharm Bull 2008;31:299-304.
• 40. Schmid DA, Depta JP, Pichler WJ. T cell-mediated hypersensitivity to quinolones: mechanisms and cross-reactivity. Clin Exp Allergy 2006;36:59-69.
• 41. Ingelman-Sundberg M. Pharmacogenomic biomarkers for prediction of severe adverse drug reactions. N Engl J Med 2008;358:637-9.
• 42. Ronaldson KJ, McNeil JJ. Improving drug safety by locating genetic markers for hypersensitivity reactions. Med J Aust 2009;190: 641-3.
• 43. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al; European Network for Drug Allergy (ENDA); EAACI interest group on drug hypersensitivity. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003;58:854-63.
• 44. Bousquet PJ, Pipet A, Bousquet-Rouanet L, Demoly P. Oral challenges are needed in the diagnosis of betalactam hypersensitivity. Clin Exp Allergy 2008;38:185-90.
• 45. Bahna SL, Khalili B. New concepts in the management of adverse drug reactions. Allergy Asthma Proc 2007;28:517-24.
• 46. Woo HY, Kim YS, Kang NI, Chung WC, Song CH, Choi IW, et al. Mechanism for acute oral desensitization to antibiotics. Allergy 2006;61:954-8.
• 47. Castells M. Desensitization for drug allergy. Curr Opin Allergy Clin Immunol 2006;6:476-81.
• 48. Demoly P, Pichler W, Pirmohamed M, Romano A. Important questions in Allergy: 1-drug allergy/hypersensitivity. Allergy 2008; 63:616-9.