Drug hypersensitivity. Hypersensitivity reactions: T cell-mediated delayed-type hypersensitivity (type IV). Preparations for general anesthesia, anesthetics

A drug allergy is an adverse reaction to a drug, often an antibiotic, that affects the body's immune system. Drug hypersensitivity is an unusual reaction to a drug without immune system. Some people have allergies or sensitivities to medications that are not harmful to most. Some drugs, such as aspirin and penicillin or related antibiotics, can cause severe allergic reactions in some people and hypersensitivity in others.

How dangerous are allergic reactions to medications?

Drug allergies account for 5-10 percent of all adverse drug reactions. They occur when the immune system, designed to protect the body from foreign substances such as bacteria and viruses, recognizes the drug as harmful substance which must be destroyed. Medicines often trigger an immune response; however, only a small number of people experience symptoms of an allergic reaction. Although most allergic reactions to medications have mild symptoms, in rare cases they can be life-threatening. Drug allergies are unpredictable. Most drug allergies develop within a few days to a few weeks after starting drug treatment. Unlike other types of adverse drug reactions, the frequency and severity of allergic drug reactions are usually not dependent on the amount of drug administered. Even a very small amount of medicine can cause an allergy.

Which drugs are most likely to cause allergies?

Many classes of medications can cause allergic reactions, resulting in a wide range of symptoms affecting different tissues and organs. The likelihood that a drug will cause an allergic reaction depends in part on its chemical properties. Larger drug molecules are more likely to cause allergic reactions than smaller molecules. Large molecule drugs include the following:

• insulin,
• antiserum,
• recombinant proteins.

Unlike most other allergens, such as pollen or mold spores, drug molecules are often too small to be identified by the immune system. Drugs such as antibiotics cannot induce an immune response unless they are combined with, for example, a carrier protein. In addition, drug allergies are often caused by breakdown products or metabolites of the drug, rather than by the drug itself. Sometimes the same drug, for example penicillin, can cause Various types allergic reactions.

How does an allergy to a medicine occur?

Most allergies, including drug allergies, result from a reaction with an immune system antibody called immunoglobulin E (IgE). The first exposure to the drug sensitizes the immune system, causing specialized white blood cells to produce IgE, which recognizes the specific drug. Upon subsequent exposure to the drug, drug-specific IgE antibodies bind to the drug on the surfaces of certain immune system cells. This binding activates cells to release histamine and other chemical substances, which can cause various symptoms. Thus, a person who does not have a reaction to the first exposure to a drug may have a severe reaction with subsequent exposure.

Antibodies responsible for an allergic reaction

Specific IgE antibodies cross-combine with drugs that have similar Chemical properties, thereby causing an allergic reaction, as is the case with penicillin. For example, antibodies sensitive to penicillin may cross-react with antibiotics, in particular amoxicillin or nafcillin. Insect bites and intravenous injections of certain medications are the most common causes of anaphylaxis, the most severe allergic reaction. Anaphylaxis affects the entire body and is most common in people who are allergic to penicillins and similar drugs. These drugs cause 97 percent of all deaths due to an allergic reaction.

Specific types of allergic reactions

Some allergic reactions to drugs involve components of the immune system other than IgE. Cytotoxic and cytolytic drug allergies occur when a drug allergen, which is bound to a cell membrane, usually in the blood, interacts with other types of antibodies—immunoglobulin G (IgG) or immunoglobulin M (IgM), along with other immune system factors. These interactions damage or destroy the body's cells.

Immune complex allergic reactions occur when a drug combines with antibodies and other components of the immune system to form complexes in the blood. These complexes can be deposited in blood vessels and on membranes, causing inflammatory reactions that can be localized or found throughout the body. For example, serum sickness usually causes a rash on the skin and affects the joints.

Hypersensitivity to drugs

Hypersensitivity to a drug (also called idiosyncratic reactions or unusual adverse reactions) does not involve the immune system or histamine release. However, the symptoms of drug hypersensitivity can be very similar to the symptoms of drug allergies. Unlike drug allergies, however, this condition often occurs upon first exposure to a drug and does not lead to anaphylaxis.

Who is at high risk for drug allergies

Anyone can experience an allergy to any drug at any time. It is not known, however, why some people are allergic to medications that are well tolerated by most people. It is estimated that up to 10 percent of drug allergies involve a reaction to penicillin or other antibiotics. Those who are taking multiple medications or undergoing frequent courses treated with antibiotics are more at risk of developing drug allergies. The most common hypersensitivity is to aspirin. A huge number of people, especially adults, are sensitive to aspirin. However, many medications, including aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, can trigger an asthma attack. Aspirin and aspirin-containing drugs are common triggers for asthma attacks in 30 percent of asthmatics.

Causes of allergic reactions to drugs

Any medicine can cause an allergic reaction; however, antibiotics, especially penicillin and related drugs, are the most common cause of drug allergies. Allergies also often develop to the following:

• aspirin,
• preparations based on sulfates,
• barbiturates,
• anticonvulsants,
• insulin preparations, especially preparations for animals,
• dyes for procedures.

Symptoms of drug allergies range from fairly mild forms to life-threatening anaphylaxis. Unlike other common allergies, drug allergies often affect the entire body. The most common symptoms of such allergies are skin problems, including rash, itching and hives. The type of rash depends on the type of allergic response. Less common symptoms of drug allergies include runny nose, sneezing, and nasal congestion.

Unusual but more serious symptoms of drug allergies include the following:

• nausea,
• vomit,
• abdominal pain or cramps,
• fever,
• low blood cell count
• labored breathing,
• inflammation of the lungs, kidneys and joints,
• angioedema (sudden swelling of mucous membranes and tissues).

What is angioedema

Angioedema occurs within a few minutes of exposure to the drug, often in combination with urticaria. Angioedema is often asymmetrical: for example, it may affect only one side of the lips. Swelling of the tongue, mouth, and airways may cause difficulty swallowing or breathing. Angioedema can become life-threatening if the swelling affects the larynx, blocking the air passages. Emergency symptoms of drug allergies include throat obstruction from swelling, severe asthma attack, and anaphylaxis.

Allergic reactions to drugs are the most common cause of kidney inflammation, or tubulointerstitial nephritis. An allergic reaction and the development of this acute condition may occur in the fifth week of taking penicillin, sulfonamide, diuretics (drugs to increase urination), aspirin and other NSAIDs.

IgE-mediated allergies can be caused by the following:

• penicillin,
• antiserum,
• hormones,
• vaccines (usually an allergic reaction to some component of the vaccine, e.g. egg white, gelatin or neomycin, an antibiotic),
• very rarely local anesthetics such as novocaine.

The most common symptom of an IgE-mediated drug allergy is a rash that develops after a person has taken a drug for several days and has produced antibodies against it.

What is anaphylaxis

Anaphylaxis is an immune system reaction that can occur after taking a large number of drugs and exposure to specific IgE antibodies. Antibodies bind to the drug very quickly, causing an immediate, severe response. Anaphylaxis is most often caused by:

• penicillin and related antibiotics,
• streptomycin,
• tetracycline,
• insulin.

Anaphylaxis usually begins 1-15 minutes after exposure to the drug. Rarely does the reaction begin an hour or more after exposure. Anaphylaxis can progress very quickly, leading to collapse, convulsions and loss of consciousness within one to two minutes. Without treatment, cessation of breathing, anaphylactic shock and death can occur within 15 minutes. Any drug that causes anaphylaxis is likely to cause it again with subsequent use unless certain measures are taken.

Symptoms of anaphylaxis

Symptoms of anaphylaxis include:

• hives on different parts bodies,
• angioedema,
• intense itching,
• skin irritation,
• cough and sneezing,
• nausea, vomiting, diarrhea,
• stomach pain or cramps,
• tingling,
• increased heart rate and pulse,
• sudden extreme anxiety
• swelling of the throat and compression of the air passages, which causes hoarseness and difficulty wheezing - the most characteristic symptom anaphylaxis.

Narrowing of the air passages in the bronchial tract and throat, accompanied by shock, can lead to a sharp decrease in blood pressure, which in turn can cause the following:

• fast pulse,
• pallor,
• weakness,
• dizziness,
• slurred speech
• mental problems,
• unconsciousness.

Allergy to cytotoxic and cytolytic drugs

Allergies to cytotoxic and cytolytic drugs may be caused by the following:

• penicillin,
• sulfonamides,
• Quinidine

The cytotoxic or cytolytic type of drug allergy can lead to the following:

• immune hemolytic anemia due to the destruction of red blood cells,
• thrombocytopenia due to decreased platelets,
• granulocytopenia due to a deficiency of granular leukocytes.

Allergies involving the immune complex

Medicines that can cause immune complex reactions, such as serum sickness or lupus syndrome, include:

• hydralazine,
• procainamide,
• isoniazid,
• phenytoin.

Serum sickness (a type of drug allergy) can be caused by an allergic reaction to penicillin or related antibiotics. The illness may also be an allergic response to animal proteins present in the injectable drug. Serum allergy is characterized by the following:

• fever,
• joint pain,
• tumor of the lymph nodes,
• rash,
• swelling of the whole body,
• skin lesions,
• nephritis (kidney inflammation),
• hepatitis (liver inflammation).

Dermatological allergic reactions

Some drugs, including penicillins and sulfonamides, can cause delayed dermatological allergic reactions. These are various types of skin reactions, including eczema, that do not occur immediately after exposure to the drug. These types of allergies are thought to be caused by metabolites formed as a result of the breakdown or further reaction of the drug. Allergies to medications can lead to hypersensitivity reactions, which in turn can lead to liver problems. Such damage may be caused by the following:

• sulfonamides,
• phenothiazines,
• halothane,
• phenytoin,
• isoniazid.

Pulmonary hypersensitivity affects the lungs and leads to rash and fever, and may be caused by nitrofurantoin and sulfasalazine.

Hypersensitivity and allergy to aspirin

Some people (usually children) may be hypersensitive to aspirin and other NSAIDs, as well as opiates such as morphine and codeine, and some antibiotics including erythromycin and ampicillin. Symptoms of drug hypersensitivity are often very similar to those of drug allergies and include rash, hives, and angioedema. Anaphylactoid drug reactions similar to anaphylactic reactions. However, they are caused by hypersensitivity to drugs, and not allergy to drugs, and can occur already at the first contact with the drug. Anaphylactoid reactions can occur in response to opiates, radiopaque dyes, aspirin and other NSAIDs, polymyxin, pentamidine.

When to see a doctor

A physician should be consulted if a person experiences an allergic reaction or sensitivity to specific drug. Seek emergency help if a person has a severe or rapidly worsening allergic reaction to the drug; symptoms include wheezing, difficulty breathing and other signs of anaphylaxis.

Diagnosis of drug allergies

Diagnosis of drug allergies may depend on the following:

Allergy tests

Allergy tests are standardized for very few drugs. The penicillin test is standardized and can be used in extreme situations. Incremental tests are also available for several drugs. Patch tests can be used to test for drug allergies in the skin. Desensitization is a test in which the allergist gives the patient a small dose of the drug in a conventional form - orally, topically, or by injection. Gradually the dose is increased and a reaction is observed. However, this procedure is only performed in life-threatening situations and only with careful observation.

Mild allergic reactions - treatment

Drug allergies and sensitivities are most often treated by stopping medications and changing them alternative options. Mild symptoms usually disappear within a few days after stopping the drug. Rash and hives can be treated with oral antihistamines. Topical corticosteroid medications are sometimes used.

Treatment of severe allergic reactions

Serious immediate reactions that occur within an hour of drug administration, accelerated reactions that occur one to two hours after drug exposure, and late reactions (including rash, serum sickness, or fever) that occur more than 72 hours after drug exposure , are treated as follows:

• stopping all suspicious medications,
• use of antihistamines,
• use of oral corticosteroids for inflammation.

Severe angioedema requires immediate injection of epinephrine (or a form of epinephrine) and further observation in hospital. Anaphylaxis requires an immediate injection of epinephrine into the thigh muscle. Adrenaline opens the air passages and improves blood circulation. Intravenous fluids and injections of antihistamines or corticosteroids such as hydrocortisone are also given. Cardiopulmonary resuscitation and intubation may be required. Asthma attacks caused by aspirin or other drugs can be eliminated with adrenaline, short-acting bronchodilators, and prednisone.

Desensitization (immunotherapy)

Desensitization or immunotherapy is sometimes used by an immunologist to treat allergies to drugs, particularly insulin, penicillin, or other antibiotics. A small amount of the drug is injected or swallowed over several hours or several days in slowly increasing doses to reduce sensitivity. Once desensitization has been achieved, full course antibiotic treatment. The procedure must be repeated if the drug has been discontinued for more than 72 hours.

Denial of responsibility: The information provided in this article about drug allergies is intended for the reader's information only. It is not intended to be a substitute for advice from a healthcare professional.

RCHR ( Republican Center healthcare development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2016

Allergic urticaria(L50.0), Anaphylactic shock due to a pathological reaction to an adequately prescribed and correctly administered drug (T88.6), Anaphylactic shock associated with the administration of serum (T80.5), Angioedema (T78.3), Generalized rash on skin caused by drugs and medications (L27.0), Other erythema multiforme (L51.8), Drug photoallergic reaction (L56.1), Localized skin rash caused by drugs and medications (L27.1), Nonbullous erythema multiforme (L51.0), Pathological reaction to drug or drugs, unspecified) (T88.7), Irritant contact dermatitis caused by drugs in contact with skin (L24.4), Toxic epidermal necrolysis [Lyella] (L51.2)

Allergology

general information

Short description

Approved
Joint Commission on Healthcare Quality
Ministry of Health and social development Republic of Kazakhstan
dated September 15, 2016
Protocol No. 11

Drug hypersensitivity- this is an increased sensitivity of the body to drugs, the development of which involves immune mechanisms.
NB! Considering that the clinical manifestations of PH are not specific, they are coded according to the medical diagnosis code of the disease.

see Attachment.

Date of protocol development: 2016

Protocol users: doctors of all profiles.

Level of evidence scale:

Classification

Classification

I. Predictable adverse reactions to drugs: toxicity, overdose, pharmachologic effect, teratogenic effect, etc.
II. Unpredictable adverse reactions to drugs:
· non-allergic congenital hypersensitivity (or idiosyncrasy);
drug hypersensitivity:
- allergic PH);
- non-allergic (pseudo-allergy).

Classification of PH depending on the mechanism of development.

Diagnostics (outpatient clinic)

OUTPATIENT DIAGNOSTICS

Diagnostic criteria
Complaints: Patient complaints depend on the manifestation of PH and can occur with primary damage to individual organs or have systemic manifestations.

Anamnesis:
Properly assembled pharmacological history(patient interview and study of medical documentation):
· what drug the reaction developed to (or what drugs were taken at the time the reaction developed);
· what day from the start of taking the drug;
· route of administration of the drug;
· how long after the last drug intake did the reaction develop;
· in what dose the drug was used;
· clinical manifestations of the reaction;
· how the reaction was stopped;
What was the drug used for?
· have there been any previous reactions to drugs;
· did you take drugs from this group or cross-reacting ones after the reaction;
· what medications he takes and tolerates well.

Allergy history:
· assessment of the patient’s allergological status (presence of atopic diseases, spectrum of sensitization, etc.);
· family allergy history.
Concomitant pathology can aggravate the course of the reaction and provoke the development of non-allergic hypersensitivity.

Physical examination: clinical manifestations of PH can occur with primary damage to individual organs or have systemic manifestations.
It is important to search for dangerous and severe symptoms, which include clinical symptoms, as well as some laboratory parameters.

Skin lesions due to drug hypersensitivity

Diagnostics (hospital)

DIAGNOSTICS AT THE INPATIENT LEVEL

Diagnostic criteria: see outpatient level.

Diagnostic algorithm: cm. outpatient level.

List of main diagnostic measures:
· general blood analysis;
· biochemical analysis blood - determination of ALT, tryptase (if equipment is available), immunoglobulin E, creatinine, urea, sodium, total and ionized calcium, potassium, phosphorus, chlorine (not strictly specific);
· determination of venous blood in the acid-base balance (not strictly specific).

List of additional diagnostic measures:
· general urinalysis (not strictly specific, for differential diagnosis);
· coagulogram (prothrombin time, fibrinogen, thrombin time, aPTT) (if complications develop, not strictly specific);
· Ultrasound abdominal cavity(not strictly specific, for differential diagnosis);
· biochemical blood test (AST, C-reactive protein (quantitative)) (not strictly specific, for differential diagnosis);
· ELISA - CMV, EBV, HSV (not strictly specific, for differential diagnosis, treatment of complications);
· determination of procalcitonin in blood serum (not strictly specific, for differential diagnosis, assessment of the patient’s condition);
· blood test for ANA, ENA, TSH (not strictly specific, for differential diagnosis and treatment of complications);
· PCR for cytomegalovirus, herpes simplex virus types 1 and 2, Epstein-Barr virus (not strictly specific, for differential diagnosis and treatment of complications);
· provocative dosed tests.

N.B.! This test is carried out by an allergist-immunologist in a hospital setting according to strict indications when it is impossible to replace it with drugs from other groups. PDT with the administration of the drug in a full therapeutic dose is the gold standard for identifying a causally significant drug (C) and is carried out in a hospital setting with an intensive care unit if it is impossible to replace the drug with an alternative one. An oral challenge test is safer. PDT should be carried out no earlier than 1 month after the reaction (UD-D).

Precautions and contraindications for conducting a provocative dose test

Differential diagnosis

in medical documentation, the nosological diagnosis and main manifestations of the disease should be indicated first; Drug hypersensitivity caused by the name of the causally significant drug. If in the anamnesis, then it is written clinically or confirmed in diagnostic tests.

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Treatment

Drugs (active ingredients) used in treatment

Treatment (outpatient clinic)

OUTPATIENT TREATMENT

Treatment tactics

Non-drug treatment:
Mode: depends on the severity of the patients' condition.
Diet: a hypoallergenic diet allows you to reduce the amount of mediators in the body. Recommended for at least 10-15 days. It is recommended to increase the volume of fluid consumed. It is necessary to consume up to 2-2.5 liters of liquid per day;

Drug treatment:
Treatment of PH mild degree severity:
· if the medicine was taken orally, the patient is prescribed gastric lavage, a cleansing enema and sorbents (activated carbon 10 tablets/day);
· 2nd generation antihistamines in an age dosage of 7-10 days;
· drink plenty of fluids.

List of essential medicines:

Adrenergic agonists (UD - A):

Glucocorticosteroids (UD - A):

Antihistamines 1st generation (UD - 2B):
Antihistamines 2-3 generations (UD - 2B):

Treatment (ambulance)

DIAGNOSIS AND TREATMENT AT THE EMERGENCY CARE STAGE

Diagnostic measures:
Complaints: Patient complaints will depend on the manifestation of PH and may occur with primary damage to individual organs or have systemic manifestations.

Anamnesis:
· presence of allergic predisposition;
· pre-existing allergic reactions to medications;
· establish the use of medications within the next minutes, hours, 1-2 days;
· to establish possible cross-reactions with previously existing medications in the anamnesis that cause an allergic reaction.

Physical examination: manifestations of PH can occur with primary damage to individual organs or have systemic manifestations (see Table 2). Assessment of the objective condition with assessment of hemodynamic parameters and clinical symptoms, according to the algorithm.

Clinical and biological signs suggesting severe cutaneous and/or systemic reactions.

Drug treatment provided at the emergency stage, see general treatment.

Treatment (inpatient)

INPATIENT TREATMENT

Treatment tactics:
· immediate withdrawal of suspected causally significant drugs and cross-reacting drugs;
· treatment is carried out in accordance with the standards for the treatment of clinical manifestations;
· if it is necessary to use a causally significant drug according to absolute indications, a confirmed allergic reaction mechanism, desensitization is carried out by an allergist-immunologist in a hospital setting.

Treatment of PH medium degree severity:
· if the medicine was taken orally, the patient is prescribed gastric lavage, a cleansing enema and sorbents (activated carbon at the rate of at least 1 tablet/1 kg of body weight per day);
· 2nd generation antihistamines in an age dosage of 7-15 days;
· glucocorticosteroids (for prednisolone 60-300 mg/day);
infusion therapy ( saline solutions).

Treatment of severe PH:
· use of epinephrine;
· with the development of an anaphylactic reaction, treatment is carried out according to the CP Anaphylactic shock, with the development of Quincke's edema (treatment according to the CP), Lyell's syndrome (TEN) - additional use of human intravenous immunoglobulin G (from 0.5 to 2 g per kg of body weight), Stevens syndrome - Johnson (treatment according to KP).
· glucocorticosteroids (for prednisolone 180-360 mg/day);
· infusion therapy (saline solutions);
· injectable antihistamines.

Indications for consultation with specialists: see outpatient level.

Indications for transfer to the intensive care unit:
· presence of anaphylactic shock of any form and severity;
· Quincke's edema with the development of respiratory failure;
acute cardiovascular and respiratory failure;
· acute internal combustion engine syndrome.

Indicators of treatment effectiveness: see outpatient level.

Further management: issuing a passport to a patient with hypersensitivity to drugs and selecting alternative life-saving drugs.

Hospitalization

INDICATIONS FOR HOSPITALIZATION, INDICATING THE TYPE OF HOSPITALIZATION

Indications for emergency hospitalization:
· anaphylactic shock;
· Quincke's edema of moderate and severe course;
· acute urticaria moderate and severe course;
· Stevens-Johnson syndrome;
Lyell's syndrome (LEN);
· broncho-obstructive syndrome and laryngospasm of moderate and severe course;
systemic drug-induced vasculitis;
· DRESS;
Serum sickness.

Indications for planned hospitalization: preparation of patients with hypersensitivity to many drugs for surgical interventions and selection of life-saving drugs for therapeutic patients. Conducting a trial treatment.

Information

Sources and literature

1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2016
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Information

ABBREVIATIONS USED IN THE PROTOCOL

Application
to the clinical protocol
diagnosis and treatment

Hypersensitivity- increased sensitivity of the body to any substance. Hypersensitivity is an unwanted overreaction of the immune system and can lead not only to discomfort, but also to death.

Classification

The first classification of types of hypersensitivity was created by R. Cook in 1947. He distinguished two types of hypersensitivity: immediate hypersensitivity, caused by humoral immune mechanisms and developing after 20-30 minutes, and delayed type hypersensitivity, caused by cellular humoral immune mechanisms, occurring 6-8 hours after contact with the antigen.

HNT is associated with the production of specific antibodies by B-lymphocytes and can be transferred from a sick person to a healthy person using serum containing antibodies (according to Küstner-Prausnitz) or a reactive clone of B-lymphocytes. Specific desensitization of the patient is possible, which in some cases gives a lasting effect.

HRT is mediated by cellular immune responses. Transfer is possible using a reactive T-lymphocyte clone. Desensitization is not possible.

This classification was revised in 1963 by British immunologists Philip Jell. Philip George Houthem Gell) and Robin Coombs (eng. Robin Coombs). These researchers identified four types of hypersensitivity:

• Type I - anaphylactic. Upon initial contact with the antigen, IgE, or reagins, are formed, attached by the Fc fragment to basophils and mast cells. Repeated introduction of the antigen causes its binding to antibodies and cell degranulation with the release of inflammatory mediators, primarily histamine.
• Type II - cytotoxic. An antigen located on the cell membrane (either part of it or adsorbed) is recognized by IgG and IgM antibodies. After this, the cell is destroyed by a) immune-mediated phagocytosis (mainly by macrophages when interacting with the Fc fragment of immunoglobulin), b) complement-dependent cytolysis or c) antibody-dependent cellular cytotoxicity (destruction by NK lymphocytes when interacting with the Fc fragment of immunoglobulin).
• Type III - immunocomplex. Antibodies of the IgG and IgM classes form immune complexes with soluble antigens that can be deposited in the absence of lysing complement on the vascular wall and basement membranes (deposition occurs not only mechanically, but also due to the presence of Fc receptors on these structures).

The above types of hyperreactivity refer to GNT.

• Type IV - HRT. Interaction of antigen with macrophages and type 1 T-helper cells with stimulation of cellular immunity.

They also highlight separately type V hypersensitivity- autosensitization caused by antibodies to cell surface antigens. This additional typification was sometimes used as a distinction from Type II. An example of a condition caused by type V hyperreactivity is hyperactivity thyroid gland with Graves' disease.

History of the study

see also

Notes

Literature

• Pytsky V. I., Andrianova N. V. and Artomasova A. V. Allergic diseases, p. 367, M., 1991.

Links

• All about hypersensitivity and the mechanisms of its implementation
• Hypersensitivity as an aggravated form of the immune response

We all occasionally take various medications. They help us get rid of minor ailments or serious health problems. But, as practice shows, only a small number of people take medication seriously. After all, even the simplest medications can pose a serious threat to health, causing side effects and allergic reactions. Therefore, the instructions for all drugs indicate contraindications: hypersensitivity to the components of the drug, age, illness and other factors.

Any medication can cause an allergic reaction. This is an individual feature of the body that occurs when some component of the drug enters the body.

What causes hypersensitivity to drug components?

Specific allergic reactions to pharmaceuticals can occur in several categories of patients.

Sometimes individual intolerance develops in patients who receive medications for any disease. In this case, unpleasant symptoms often do not occur immediately, but only with repeated administration or consumption of medications. Sensitization and synthesis of antibodies occurs in the body during the interval between taking two doses of the drug. Sometimes an allergy occurs completely unexpectedly - after the first use of the drug.

Quite often, individual intolerance to drug components is observed among professional workers who are forced to constantly come into contact with drugs. This group of people includes nurses, doctors and pharmacists. Sometimes a severe form of allergy to medications forces them to completely change their work activity.

In ordinary users, allergic reactions occur most often in cases where the medicine has a significant mass (volume) or is administered parenterally (intravenously, intramuscularly or locally - on the skin or mucous membranes).

What components of drugs provoke the appearance of symptoms of individual intolerance?

Among the drugs that most often cause allergies are protein drugs, for example, immune serums, hormonal and antibacterial drugs.

So, for example, penicillin administered in the form of an injection can cause serious complications in a sensitized patient.

Quite often, reactions of individual intolerance are caused by sulfur-containing drugs, iodine compounds, painkillers and those medications that are used in the form of ointments or creams. Allergic reactions can be provoked not only active ingredients, but also additives that are contained inside tablets or ointments, for example, preservatives or dyes.

If a person has any allergies, he is considered more susceptible to individual drug intolerance. This predisposition is also observed in those who suffer from fungal diseases. It is worth noting that taking certain medications can cause skin sensitization to daylight, which can cause sun allergies.

In some cases, allergic reactions occur when consuming antihistamines, which are aimed at correcting other forms of allergies.

It is imperative to distinguish individual intolerance from side effects medication, as well as from the symptoms that occur with an overdose of the drug.

Types of individual intolerance and methods of their correction

Anaphylactic shock

This is the most serious form of drug allergy and begins with a feeling of heat, redness or paleness of the skin, which may break out in a cold sweat.

The patient develops a strong feeling of fear and agitation. The victim may also experience throbbing headaches, tinnitus, pain behind the sternum and in the lumbar region. Also, symptoms of approaching anaphylactic shock include an attack of suffocation and a feeling of lack of air.

Subsequently, the victim experiences a sharp decline blood pressure, he loses consciousness, and convulsions may develop. In addition, swelling of the larynx may occur.

If anaphylactic shock develops, it is necessary to immediately stop the administration of the drug, and after the intravenous injection, a tourniquet should be applied just above the injection site. The victim should be placed on his back, and his head should be turned to the left. Call ambulance and give the patient an antihistamine.

Collapse

Sometimes individual intolerance to drug components leads to collapse - acute vascular failure. This disorder is accompanied by the appearance of severe weakness, dizziness and darkening of the eyes. The patient turns pale, his temperature and blood pressure drop, there is tinnitus and a feeling of thirst. Shortness of breath is often observed, and fainting may develop.

The first step is to lay the victim on his back, raise his legs and unbutton his clothes. Next, you should provide the patient with access to fresh air, use ammonia and call an ambulance.

Hives

Individual intolerance to drug components can lead to urticaria. In this case, blisters appear on the patient’s skin, the victim is bothered by itching, the temperature may rise, a headache and a feeling of general malaise may occur.

If urticaria develops, you should discontinue the medication, take an antihistamine and activated charcoal. It would also be a good idea to wipe the area of ​​the rash with a soda solution and consult a doctor.

Possible manifestations of allergies to drug components also include small papular rash, erythema multiforme, eczema, etc.

Recommendations for patients with individual intolerance to drug components
All patients who suffer from any allergies or have experienced allergies to medications must inform their doctor about this before using any medications.

Drug hypersensitivity is an immune-mediated reaction. Symptoms of hypersensitivity can be mild or severe and may include skin rash, anaphylaxis, and serum sickness. The diagnosis of this condition usually becomes clinical, informative, in such cases it is necessary to conduct skin tests.

At the beginning of treatment, it is necessary to exclude drugs that cause hypersensitivity, as well as prescribe antihistamines. Drug hypersensitivity is classified with toxic as well as side effects, which most often occur when medications are prescribed individually or in combination.

Pathophysiology of hypersensitivity

Some proteins, as well as drugs, such as insulin, can act as stimulants in the production of antibodies. A large number of drugs are haptens in nature, which, in turn, bind to cellular proteins and include proteins that are part of the molecules.

When bound in this way, the proteins become immunogenic and stimulate antibodies against drugs.

It is not clear exactly how sensitization occurs, but if a particular drug stimulates an immune response, a drug response is observed.

It must be remembered that visible reactions can be not only allergic. An example would be a drug such as amoxicillin; it usually causes a rash, but it is not allergic and this drug can also be prescribed after a reaction, only after a period of time.

Symptoms of hypersensitivity

Symptoms of hypersensitivity vary depending on the patient and the drug they took. The same medications may have different effects in different patients because each person's response is different.

An anaphylactic reaction is a serious reaction, most often urticaria is present, and in some cases febrile attacks can be observed. Reactions that are persistent in nature are less common. Other syndromes that can be identified clinically can also be noted.

Serum sickness usually does not appear until 10 days after exposure to the drug, initially with fever and subsequently a rash. Some patients suffer from severe arthritis and swelling. Symptoms can be self-limited and can last from one to two weeks.

This condition is often caused by drugs such as:

• antibiotics;
• sulfonamide drugs;
• carbamazeline.

Possible development hemolytic anemia, but it only develops if an antibody-drug-red blood cell complex is formed, or if the drug alters the red blood cell membrane, which exposes antigens that induce antibody production.

There are also drugs that can cause lung damage. For example, nephritis is a very common reaction that occurs in the kidneys. This condition is caused by drugs such as cimetidine, methicillin.

Diagnosis of drug hypersensitivity

Diagnosis is made in cases where a reaction to certain medications develops within a short time, and this can occur after a period of time after taking the drugs.

But many patients experience a late reaction, the nature of which has not yet been determined. Skin tests are performed in cases of hypersensitivity. But approximately 20 percent of patients who have a reaction to the drug note that the test results show a positive reaction. For many drugs, taking a skin test is unreliable, since they only diagnose allergies, while the development of a rash and the prognosis of allergies are not relevant here, nor can there be anemia and nephritis.

Penicillin samples are also taken, they must be taken from patients whose hypersensitivity is of a delayed type, and they must also be prescribed penicillin. The first step is to use the injection technique. If the patient experiences violent reactions, then to carry out this test it is necessary to take a diluted drug. If the result of such a test is negative, then it would be advisable to conduct skin tests. If the result of such a test is positive, then treatment with penicillin can cause anaphylactic shock. If the results are negative, then such a connection is unlikely, but not completely excluded. Tests are carried out immediately before starting penicillin therapy.

When skin testing is performed on patients who do not have atopy and have not previously received skin serum preparations, the first step is to perform a prick test. In patients with hypersensitivity, a blister appears after 15 minutes. Also, regardless of what the first reaction was, patients are given the first test in a diluted state.

To conduct provocation tests, drugs are taken that can lead to a hypersensitivity reaction when the dose of their use is increased. This test is safe and very effective only if done under supervision. Samples for drugs can be direct or indirect. Tests can also cause other types of hypersensitivity, such as:

• release of histamine;
• mast cell degranulation;

But in general, we can conclude that these samples are only at the stage of experimental processing.

Treating a condition called hypersensitivity

After a certain time, hypersensitivity to drugs decreases. Hypersensitivity in 90 percent of patients after an allergic reaction persists for a year, and 10 percent of patients may encounter such a problem that they will have for 10 years. Patients who are characterized by anaphylaxis suffer from increased hypersensitivity to drugs longer, and it usually persists for a longer time.

Patients who are allergic to medications should avoid those medications to which they have an unusual reaction or cause negative consequences, and wear an “alarm” bracelet. The hospital card must be marked and there must be an indication of the drug that causes the allergic reaction. Treatment, first of all, consists of stopping the use of drugs to which the reaction is allergic. After several days of taking the drugs, symptoms and complaints become more clear. Treatment of acute reactions involves the administration of drugs that relieve itching; in case of anaphylaxis, adrenaline is administered.

And conditions such as fever, skin rash, meaning non-itchy, do not require treatment. In principle, they go away on their own after a short period of time.

Desensitization

Desensitization may be necessary only if sensitivity is urgently required, as well as treatment with the necessary drug for a long time.