Current Approach to Drug Allergy in Children

Yıl 2018, Cilt: 10 Sayı: 2, 42 - 49, 06.03.2018

Doç. Dr. Himmet Haluk Akar

Öz

Abstract

Adverse drug reactions (ADR) are defined as the reactions that occur during theuse of drugs. When questioned, about 10 % of the parents report ADR to at least onedrug in their children. Type A reactions account for 8-95 % of ADRs which are associated with the pharmacological effects of drugs. These reactions are dose-dependent, reversible, and clinically anticipated. On the other hand, Type B ADRs account for 20 % of ADRs which are clinically unexpected outcomes and less dose-dependent reactions as known drug hypersensitivity. A detailed anamnesis is the mostimportant part of diagnosis in patients with drug allergy as in all diseases. At first, suspected drug or drugs should be determined with anamnesis, after that the reactions should be classified. For the definitive diagnosis, based on the anamnesis, different diagnostic tests should be applied. In the acute management ADRs, culprit drug must be stopped and other supportive medical supplies shouldbe applied to the patient for acute management. It is so important to make a long-term management plan for future possible reactions in patients with ADR. In this review,the practical approaches of drug allergies will be reviewedin paralleled with current guidelines in children.

Anahtar Kelimeler

Drug Allergy, Childhood, Therapy, Diagnosis

Çocuklarda İlaç Alerjilerine Güncel Yaklaşım

Öz

Öz

Bir ilacın kullanımı sırasında oluşan reaksiyonlara istenmeyen ilaç reaksiyonları (IIR) denir. Beyana dayalı ebeveyn çalışmalarında çocukların yaklaşık % 10’u enaza bir ilaca karşı İİR’u gösterirler. IIR’nın yaklaşık % 85-90’lik kısmını ilaç kesildiğinde geri dönüşümlü, doz bağımlı ve farmakolojik özellikleri ile bağlantılı Tip Areaksiyonlar oluşturur. Tip A reaksiyonlar beklenen ve öngörülebilen reaksiyonlardır. IIR’nın yaklaşık % 10-15’lik kısmını oluşturan Tip B reaksiyonlar ise ilaç aşırıduyarlılık reaksiyonları olup öngörülemezler, daha az doz bağımlıdırlar ve beklenmedik bulgular şeklinde ortaya çıkabilirler. IIR’u ile gelen bir hastada, tüm hastalıklarda olduğu gibi iyi bir anamnez tanıda oldukça önemlidir. Öncelikle şüpheli ilaç veya ilaçlar belirlenmeli sonrasında ortaya çıkan reaksiyonun sınıflaması yapılmalı ve kesin teşhis için tanısal testlerden yararlanılmalıdır. Akut dönem tedavide şüpheli ilaç tedaviden çıkarılmalı ve diğer destek tedavilerinden yararlanılarak mevcut akut tablo yönetilmelidir. Bu hastalar için gelecekteki olası reaksiyonlar açısından uzun dönem hasta yönetimi planı yapılması son derece önemlidir. Bu derlemede çocuklarda ilaç alerjilerine pratik yaklaşımlar güncel rehberler doğrultusunda değerlendirilecektir.

Anahtar Kelimeler

İlaç Alerjileri, Çocukluk Çağı, Tanı, Tedavi

Kaynakça

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