Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients
Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients
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DOI：
10.1159/000494130
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发表时间：
2019-01-01
影响因子：
2.8
通讯作者：
Buyukozturk, Suna
中科院分区：
文献类型：
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作者：
Demir, Semra;Erdenen, Fusun;Buyukozturk, Suna
目的：探讨药物过敏反应的潜在危险因素。方法：该研究纳入了281例对药物发生速发型超敏反应的成人患者（中位年龄40岁; 76.5%为女性）。将患者分为过敏组和非过敏组。过敏反应组根据世界过敏组织的标准进行诊断。使用罪魁祸首药物进行皮肤试验。在非过敏反应组中，使用罪魁祸首药物（包括阿司匹林或双氯芬酸）进行药物激发试验，以确定非甾体抗炎药（NSAID）超敏反应。特应性通过常见吸入性过敏原的皮肤点刺试验确定。比较两组患者的人口统计学、临床特征、基线类胰蛋白酶和总IgE水平。结果：患者病史中末次反应与研究评价之间的中位间隔为7个月（范围1-120个月）。在52.3%的患者中，反应被定义为速发过敏反应。最常见的罪魁祸首药物是NSAID（56.9%）和β-内酰胺类药物（34.7%）。在13.2%的患者中，罪犯药物被用于肠胃外。34.9%的患者有合并症，24.6%的患者使用其他药物，最常见的是抗高血压药物（10%）。28.8%的患者确定为特应性，28.1%的患者为吸烟者。基线类胰蛋白酶和总IgE的中位血清水平分别为3.5 μ g/L和77 kU/L。在46.3%的患者中，罪犯药物皮肤试验呈阳性，过敏反应组的阳性率较高（p = 0.002）。过敏反应在以下患者中更常见：高血压、特应性、使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和胃肠外接受罪犯药物（p = 0.034，p = 0.04，p = 0.03，p = 0.035，p = 0.013和p < 0.001）。在多变量分析中，观察到过敏反应组中药物的胃肠外使用和特应性的存在显著更高（p < 0.001，比值比[OR] = 20.05，置信区间[CI] 4.75-88.64; p = 0.012，OR = 2.1，CI 1.17-3.74）。年龄、吸烟、家族史、基线类胰蛋白酶和总IgE血清水平在两组之间没有差异。结论：肠外给药和过敏反应增加了药物过敏反应的风险。IgE介导的对罪魁祸首药物的敏感性似乎会促进过敏反应。(C)2018 S. Karger AG，巴塞尔
Aim: To investigate the potential risk factors in patients who have experienced anaphylaxis from drugs. Method: The study included 281 adult patients (median age 40 years; 76.5% female) who experienced immediate types of hypersensitivity reaction to a drug. The patients were divided into an anaphylaxis group and a nonanaphylaxis group. The anaphylaxis group was diagnosed according to the criteria of the World Allergy Organization. Skin testing with culprit drugs was performed. In the nonanaphylaxis group, drug provocation tests were performed with culprit drugs, including aspirin or diclofenac, to determine nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. Atopy was determined by skin prick tests with the common inhalant allergens. Patients' demographics, clinical features, and baseline tryptase and total IgE levels were compared between the 2 groups. Results: The median interval between the last reaction in the patient's history and the study evaluation was 7 months (range 1-120 months). In 52.3% of the patients, reactions were defined as anaphylaxis. The most common culprit drugs were NSAIDs (56.9%) and beta-lactams (34.7%). The culprit drugs were used parenterally in 13.2% of the patients. 34.9% of the patients had comorbid diseases and 24.6% used additional drugs, the most common being antihypertensives (10%). Atopy was determined in 28.8% and 28.1% of the patients were smokers. The median serum level of baseline tryptase and total IgE was 3.5 mu g/L and 77 kU/L, respectively. In 46.3% of the patients, skin tests with culprit drugs were positive and the positivity ratio was higher in the anaphylaxis group (p = 0.002). Anapyhlaxis was more common in patients who were: hypertensive, atopic, using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and received the culprit drug parenterally (p = 0.034, p = 0.04, p = 0.03, p = 0.035, p = 0.013, and p < 0.001). In the multivariate analysis, it was observed that the parenteral usage of the drug and the presence of atopy were significantly higher in the anaphylaxis group (p < 0.001, odds ratio [OR] = 20.05, confidence interval [CI] 4.75-88.64; p = 0.012, OR = 2.1, CI 1.17-3.74). Age, smoking, family history, and serum levels of baseline tryptase and total IgE did not differ between groups. Conclusion: The parenteral route and atopy increase the risk of drug-induced anaphylaxis. IgE-mediated sensitivity to the culprit drug seems to facilitate anaphylaxis. (C) 2018 S. Karger AG, Basel