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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