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8/12/2019 Drug Allergy- 2014 - In (D2010)
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DNG THUOCDNG THUOC
Drug allergy
A l lergie medicamenteuse
PGS. TS.Nguyn Tun Dng
A P NG M IEN DCH ( A g A b )
DNG THUOC
BIEU HIEN LA M SA NG &CA C LOA I DNG (Type I,I I ,I I I ,IV )
PHONG NGA & IEU TRDNG THUOC
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AP NG MIEN DCH
HEMIEN DCH
kn
ap ng ung mc
ap ng kem
ap ng quamc
Mien dch tnhien
Hang rao vat ly da vaniem mac
Hang rao hoa hoc ac. lactic, ac. beo,lysozyme, nc mat,nc mui, nc bot,
Hang rao tebao khanang thc bao
Mien dch thu nhan ( chuyen biet )THEDCHTHEDCH : Lym pho B (tuy xng)
TRUNG GIAN TEBAO :TRUNG GIAN TEBAO : Lym pho T (tuyen c)
M ien dch t nhien & thu nhan
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ng xam nhap cua cac tac nhan
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Thuc / nhm thuc no c tl gy d ng cao nht ?
11,6%
6,5%
4,0%
3,4%
1,3%
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K hang nguyen K hang the
K hang nguyen K hang the
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Benzylpenicillin
Benzylpenicillenic acid
NH2+ Benzylpenilloic acid
Benzylpenamaldic acid
Tissue
protein
Major haptemic
determinant
Tissue
protein
S - S
95% 5%
Minor haptemic
determinant
Formation of the benzyl penicilloyl hapten-protein complex
(Stafford C.T. Medical Times 1988)
NH
Serum Protein ElectrophoresisSerum Protein Electrophoresis
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Ag & Ac
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DNG THUOC
ac iem cua d ng thuoc
Tylerat thap K hong l ien quan en tac dung dc l y K hong phuthuoc vao l ieu Hiem khi xuat hien lan au Phan ng cheo (cross r eactivit y) Tang bach cau a acid Chuyen biet vi mot soloai thuoc phan ng bien mat khi ngng thuoc
Tng bch cu a acid
Suy thng thn (A d i s o n )
Eczema
Hen suyn
Vim ng tiu ha (E o s i n o p h i l i c g a s t r o e n t e r i t is )
Nhim k sinh trng
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BIEU HIEN L A M SA NG
Tacong tong the(multisystem involvement)
Soc phan ve anaphylaxis Penici l l in, san pham tmau, hormonpolypeptid, vaccin, dextran
Benh huyet thanh serum sickness Sulf onamides, hydantoi nes, penici l li nes,cephalosporines
Sot do thuoc drug fever M ethyldopa, procainamide, phenytoin,barbituric, quinidin, khang sinh
Tmien nhiemdo thuoc
Drug-inducedautoimmunity
Hydralazine, procainamide, isoniazid,methyldopa
Viem mach vasculitis Allopurinol,-lactam, sulfonamides,
Tacong tren cquan
Tren da Hohap Huyet hoc Tren gan Tren than Tren tebao lympho
may ayhen suyentang bach cau a acidvi em gan, matviem cau thanu bach huyet
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C CHE PHA N LOA I( Gell & Coombs )
PHAN NG
MAN CAM
TYPE I
(anaphylactic)
TYPE II
(cytotoxic)
TYPE II I
(immune complex)
TYPE IV
(cell mediated)TRIEUCHNGKHI PHAT
Nhanh< 30 phut
Nhanh5 12 gi
Nhanh3 8 gi
Cham24 48 (gi)
PHAN NGTRUNG GIAN
Thedch(IgE)
Thedch(IgG,IgM)+ bothe
Thedch(IgG)
Tebao
DIEN BIENPHAN NG
Phong hat ttebao Mast
Phan ng giaK H K T
Ket tua phc hpmien dch
Hoat hoaLympho bao
Phong t hchchatTGHH
Hoat hoa bothe * Hoat hoa bothe* KT t ebao tr ungtnh* Phan ng viem
San xuatLymphokin
BIEU HIEN
LAM SANG
HaHA
Co c tr nSoc P. ve
Huy tebao
(cytolyse)
Ton thng mo
(enzym lysosom)
Conh ai
thc bao
Truyen mauThieu mau tieuhuyet
Benh huyet thanh Quaman dotiep xuc
C CHE PHAN LOAI ( t t )( Gell & Coombs )
PHAN NGMAN CAM
TYPE I(anaphylacti
c)
TYPE I I(cytotoxic)
TYPE II I(immunecomplex)
TYPE IV(cell
mediated)
Cac tac nhangay dng
PenicillinHormonDextran
PenicillinQuinidinThiouracil
PenicillinSulfonamidHydantoin
PenicillinPhan ngtuberculin
S.pham t
mau
Sulfonamid
MethyldopaPhenyl-butazone
Chat can
quang
Ghep c
quan
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Type I - Phan ng kieu phan ve(anaphylactic)(anaphylactic)
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Le MastocyteLe Mastocyte
Mdiateurs prforms
HISTAMINEHISTAMINE
Mdiateurs noforms
PAF, prostaglandines, LT, ...
Noi meay
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Nhom mau A BO
Phan ng truyen mau
Phan ng tieu huyet tres sinh
Yeu toRhesus
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Type I I I - Phan ng tao phc hp mien dch(i mmune complex)(i mmune complex)
Hoahng ong
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Type IV - Phan ng cham (cell mediated)(cell mediated)
Eczema
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Da au, lotai
Dau goi oau, thuoc nhuom toc, knh eomat
M at M ypham, thuoc chong nang, thuoc trmun(benzoyl peroxyd), thuoc cao rau
Co Vong eo co, nc hoa
Lng Thuoc thoa tai cho, thuoc chong nang,
Nach Thuoc khmui,
Tay Savon, thuac tay giac, xi mang, nhan, vongeo tay, gang, thuoc thoa tai cho, ong ho
Dng viem da do tiep xuc
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Para-phenylenediamine
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C a d ng vi PPD cng c th gy d ngC a d ng vi PPD cng c th gy d ngcho vi cc nhm saucho vi cc nhm sau:
- Thuc nhum tc azo hay anilin.- Mt s loi thuc t, thuc m:
benzocain,procain.
- Para-aminobenzoic acid (PABA)
- Para-aminosalicylic acid
- Sulfonamide, sulfones- Carbutamide
Test phat hien dng
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M ot soth du vetest
phat hien dng
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Y EU TONGUY CYeu tolien quan en trl ieu
Ban chat cua thuoc Phan ng cheo ng sdung T Cach sdung
cau truc, trong lng PTaspi rin & NSAIDdung ngoai, dang ti em..Dung thuoc keo dai/ngat quang
Yeu tolien quan en ngi benh
Tuoi Gii
Yeu todi truyen Tien s& c a Conhieu benh
sdung nhieu thuoc Thuoc sdung trc o
treem < ngi lnkhong phu thuoc vao gii
cokhanang l ien quan en di truyenNhay cam vi tac nhanNguy c bdng cao hn
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PHONG NGA & IEU TR
Nguyen tac chung
Cach ly dnguyen, ngng & tranh sdungnhng thuoc gay dng
ieu trtri eu chng : khang histamin, corti coid Bunc vaien giai (trong trng hp mat
nc vaien giai)
Chong boi nhiem (neu co), chuyla chonkhang sinh thch hp eam bao an toan Giai man cam
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THUOC
C CHETA C ONG
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SOC PHA N V E
Phan ve(ana/phylaxie) :
khong c bao ve
ngc lai vi bao ve
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Soc phan velien quan en I gE
K hang sinh Thuoc khac Protein Hormon Enzyme IgA Thc an Con trung
Peni, Cepha, Sulfamid, Tetra.Thuoc dan c, thiopental, protaminHuyet thanh ngaACTH, insulin,...trypsin, papain, streptokinaseTruy en mauau phong, au nanhOng vove, ruoi trau,
Soc phan velien quan en phc hp mien dch
M au, hong cau, bach cau ... Huyet tng M ang ban tham cel lulose dung trong tham tch mau
Nguyen nhan
SOC PHA N V E( tt )Nguyen nhanD ng kieu soc phan ve
Do sbat thng / chuyen hoa ac. arachidoni c:A spirin, NSA ID
Tac ong t rc t iep tren tebao mast : opium vaDX , thuoc dan c, khang sinh (pol ymi cin...),
dextran, chat can quang, ... Tac nhan vat ly, Chat phugi a : sul f i t, glutamat,
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SOC PHA N V E( tt )
Bieu hien lam sangXuat hien trong vong 30 phut sau khi dung thuocDA
M A TM UIHA UPHOI
TIM M A CH
TIEU HOATHA N K INH
nga ngay, omat, noi meaynga, chay nc mat, omatchay nc mui , hat hi, nghet muiphu, khan tieng, thrtthgap, thkho, tieng ran rt,...tim ap nhanh, l oan nhp tut HA
non ma, co rut, tieu chayshai, cam thay mui kim loai ,choang vang, ngat, co giat,
Tran ngapTran ngap
Catechol ami n noiCatechol ami n noisinh trong c thesinh trong c the
* Giam oxy trong dch ke* Tch tuacid lactic* Phong thch histamin
Ngan can ng danmau tnh mach quay trvetim
Truy tim machTruy tim machGiam tuan hoan ganGiam tuan hoan ganGiam lu lng thanGiam lu lng than
Phong thch enzyme gayPhong thch enzyme gayphan giai protei nphan giai protei nvaphahuy thanh maovaphahuy thanh mao
machmachCo that c vongCo that c vong(t ien mao(t ien maomach)mach)
ong c vongong c vong(hau mao(hau maomach)mach)
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Yeu tonguy c phan ng soc phan ve
Hen suyen Thng lam cho phan ng soc phan vetrnen tram trong hn
Ngi ln tuoi Nhay cam hn vi phan ng vanhatlavi mot sothuoc can quang, khangsinh.
Thuoc ket hp Chen, c chemen chuyen, c chekenh calci .
Hormon nga thai
Dch tehoc phan ng phan ve
Penicill ine 1/100 Phan ng dng nhe
1/2500 Phan ng dng nghiem trongUSA 400-800 tvong / nam
Thuoccan quang
1/200 Phan ng dng nhe
1/2200 Phan ng dng nghiem trong
USA # 40 tvong / nam
Vaccin 0.11- 0.31ca / 100.000 lieu vaccin sdung
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Cc thuc c phn ng choCc thuc c phn ng chovi Opioid ?vi Opioid ?
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SULFONAMIDE DERIVATIVES
CLASSIFICATIONCLASSIFICATION SPECIFIC DRUGSSPECIFIC DRUGS
Antimicrobial Sulfadiazine,
Sulfamethoxazole (ie, Bactrim and Co-trimoxazole )
Carbonic Anhydrase Inhibitor Acetazolamid (Diamox)
Diuretic, Loop Bumetanide (Bumex),Furosemide(Lasid)Torsemide (Demadex)
Diuretics, Thiazide Chlorothiazide (Diuril), Chlorthalidone (Anhydro)Hydrochlorothiazide (various and combinations, eg, Diazide,Maxzids)
Hypoglycemic Agents, Oral Acetohexamide (Dymelor ),Chlorpropamide (Diabinese )Glimepiride (Amaryl ), Glipizide (Glucotrol )Glyburide (Diabeta , Glynase , Micronase )Tolbutamide (Orinase , Tol-Tab )
Other Agents Celecoxib (Celebrex )Sulfasalazine (Azulfidine )
IEU TR
Tiem 0,5 1 mladrenalin 1mg/ml (1:1000)
ng tnh mach, di da
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IEU TR
Tiem 0,5 1 mladrenalin 1mg/ml (1:1000)
Tiep tuc tiem adrenal in cach khoang 10-20 phut enkhi tnh trang benh nhan c cai thi en
Cothe dung adrenal in tac dung keo dai di dangdch treo 1/200 hay A drenal in tan / dau1 2mg/ml
Pha loang A drenal in trong dung dch Glucose 5%(4g/ml),
IEU TRPhan l ieu adrenal in theo tuoi
2 en 6 thang12 thang18 thang en 4 tuoi5 tuoi6 en 9 tuoi10 en 13 tuoi
> 14 tuoi
0,07 ml0,1 ml
0,15 ml0,2 ml0,3 ml0,4 ml
0,5 M l
0,07 mg0,1 mg
0,15 mg0,2 mg0,3 mg0,4 mg
0,5 mg
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Dung cuA na-K it sudung trong Cap cu
Dung cucap cu canhan EpiPen
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Cc dng s dng caAdrenalin trong iu tr scphn v ?
IEU TR
Di phenhydramin 25 100 mg p.o., iM , IV,...
lap lai moi 4 6 gi
M ethylprednisolone 2mg/Kg hoac 125 250 mgIV moi 6 gi(ngan nga phan ng cham)
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IEU TR
Thut ra daday :
Trng hp nghi ngloai thc an hay loai thuocnao gay ra dng
Trng hp tnh trang benh nhan c cai thiencham
IEU TRieu trtrieu chng :
Chong co thatphequan
Salbutamol 0,5cm3/4cm3 NaCl 0.9%AminophyllinThong kh quan
Chong phune
hong
A drenalin dang kh dung
Thong noi kh quanThuthuat mthong kh quan