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[药疹性皮疹的触发因素:停药、继续治疗还是脱敏?]

[Triggers of exanthematous drug eruptions: Stop intake, treat through or desensitization?].

作者信息

Absmaier M, Biedermann T, Brockow K

机构信息

Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, 80802, München, Deutschland.

出版信息

Hautarzt. 2017 Jan;68(1):29-35. doi: 10.1007/s00105-016-3907-y.

Abstract

Drug hypersensitivity reactions affect over 7% of the population and are problematic both for patients and doctors. They frequently occur in the form of exanthematous drug eruptions. The clinical manifestation of delayed hypersensitivity reactions is very variable ranging from localized fixed drug eruptions to life-threatening, severe bullous mucocutaneous eruptions or systemic drug hypersensitivity syndromes. In the case of suspicion of an exanthematous drug eruption, the causality should initially be assessed according to the proposed algorithm. If both the chronology and the clinical symptoms are indicative of a delayed drug hypersensitivity reaction, the suspected drug should be avoided. Only in cases of urgent therapeutic indications and if alternative drugs are not available, the options of "treating through" and temporary tolerance induction by "desensitization" should be considered after an individual risk-benefit analysis.

摘要

药物过敏反应影响超过7%的人口,对患者和医生来说都是难题。它们常以药疹的形式出现。迟发型过敏反应的临床表现非常多样,从局部固定性药疹到危及生命的严重大疱性黏膜皮肤疹或系统性药物过敏综合征。在怀疑是药疹的情况下,应首先根据提议的算法评估因果关系。如果时间顺序和临床症状都表明是迟发型药物过敏反应,应避免使用可疑药物。只有在有紧急治疗指征且没有替代药物可用的情况下,在进行个体风险效益分析后,才应考虑“继续治疗”和通过“脱敏”诱导暂时耐受的选择。

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