Aun Marcelo Vivolo, Blanca Miguel, Garro Laila Sabino, Ribeiro Marisa Rosimeire, Kalil Jorge, Motta Antonio Abilio, Castells Mariana, Giavina-Bianchi Pedro
Department of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.
Allergy Service, Hospital Civil, Malaga, Spain.
J Allergy Clin Immunol Pract. 2014 Jul-Aug;2(4):414-20. doi: 10.1016/j.jaip.2014.03.014. Epub 2014 May 23.
Drugs are responsible for 40% to 60% of anaphylactic reactions treated in the emergency department. A global research agenda to address uncertainties in anaphylaxis includes studies that identify factors associated with morbidity and mortality.
The present study investigated drug-induced anaphylaxis, etiologies, aggravating factors, and treatment.
A total of 806 patients with adverse drug reactions were screened, and those who had a clinical diagnosis of anaphylaxis were included in the study. Clinical and demographic characteristics of anaphylaxis were described, including etiologies, pathophysiologic mechanisms involved in the reactions, and a personal history of atopy and asthma. Factors associated with disease severity also were identified.
Anaphylaxis was diagnosed in 117 patients (14.5%). The etiologies were defined in 76% of the cases, nonsteroidal anti-inflammatory drugs being the most frequent. Seventy-eight patients (66.7%) reported a previous reaction to the drug involved in the current reaction or to a drug from the same class and/or group. Epinephrine was used to treat 34.2% of patients who presented with anaphylaxis, and 40.8% of those with anaphylactic reactions with cardiovascular involvement. IgE-mediated reactions were associated with greater severity, manifested by the rates of cardiovascular dysfunction, hospitalization, and use of epinephrine.
The prevalence of anaphylaxis is high in patients who seek medical assistance for drug reactions, but its diagnosis is missed in emergency services, and adrenaline is underused. Drugs were prescribed to many patients despite a history of previous reaction. Nonsteroidal anti-inflammatory drugs were implicated in most cases of anaphylaxis induced by drugs, and IgE-mediated reactions were less frequent but more severe.
在急诊科接受治疗的过敏反应中，40%至60%是由药物引起的。一项旨在解决过敏反应不确定性的全球研究议程包括确定与发病率和死亡率相关因素的研究。
本研究调查药物性过敏反应、病因、加重因素及治疗情况。
共筛查了806例药物不良反应患者，将临床诊断为过敏反应的患者纳入研究。描述了过敏反应的临床和人口统计学特征，包括病因、反应涉及的病理生理机制以及特应性和哮喘个人史。还确定了与疾病严重程度相关的因素。
117例患者（14.5%）被诊断为过敏反应。76%的病例明确了病因，非甾体类抗炎药最为常见。78例患者（66.7%）报告曾对当前反应所涉及的药物或同一类和/或组别的药物有过反应。34.2%出现过敏反应的患者使用肾上腺素治疗，40.8%有心血管受累的过敏反应患者使用肾上腺素治疗。IgE介导的反应与更严重的程度相关，表现为心血管功能障碍、住院率和肾上腺素使用率。
因药物反应寻求医疗帮助的患者中过敏反应患病率较高，但在急诊服务中易漏诊，且肾上腺素使用不足。尽管有既往反应史，仍有许多患者被开药。非甾体类抗炎药在大多数药物引起的过敏反应病例中起作用，IgE介导的反应较少见但更严重。
