Title Alergija na lijekove - dijagnostički pristup Title (english) Diagnostic approach to drug allergies Author Matea Kos Mentor Branka Marinović (mentor)Committee member Zrinka Bukvić Mokos (predsjednik povjerenstva)Committee member Krešimir Kostović (član povjerenstva)Committee member Branka Marinović (član povjerenstva)Granter University of Zagreb Defense date and country 2014-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Neželjene reakcije na lijekove su čest klinički problem. Koža može biti jedini
zahvaćen organ ili može biti dio ozbiljnije multiorganske reakcije. Kožne manifestacije
uključuju širok spektar pojava poput angioedema, makuloznih, papuloznih,
vezikuloznih, buloznih, vaskulitičnih i hemoragijskih lezija. Prvi korak je klinički pristup
koji uključuje detaljnu morfološku dijagnozu kožnih simptoma i znakova, isključivanje
opasnih znakova i neke osnovne laboratorijske pretrage. Morfološka dijagnostika
pomaže postaviti hipotezu o patogenezi.
Brojni lijekovi mogu se testirati in vivo – prick testom, intradermalnim i epikutanim
testovima, i in vitro - pri čemu, zbog niske osjetljivosti tih testova, jedino su pozitivni
nalazi relevantni, a negativni ne mogu isključiti preosjetljivost.
Prick test i intradermalni test koriste se za istraživanje neposredne preosjetljivosti,
a epikutani testovi i intradermalna ispitivanja odgođenog očitanja korisni su kod
kasne pojave simptoma. Epikutana ispitivanja i prick test mogu se provesti s bilo
kojim komercijalnim oblikom lijeka, dok intradermalni testovi ovise o dostupnosti
sterilnih otopina koje se koriste kod parenteralne primjene.
Provokacijski testovi, koji se smatraju zlatnim standardom, često nisu prihvaćeni
od strane pacijenata i nose opasnost od ozbiljnih reakcija. In vitro testovi imaju
prednost zbog sigurnosti postupka za pacijenta i mogu pružiti uvid u temeljne
patomehanizme same reakcije, no oni su još uvijek samo alat koji se koristi u
istraživačke svrhe, nisu standardizirani te se mogu koristiti samo kod određenih
tipova alergija na lijekove. Danas se uglavnom koristi test limfocitne transformacije.
U posljednjih nekoliko godina, kvantifikacija degranuliranih bazofila pomoću
protočne citometrije (test degranulacije bazofila) pokazao se korisnim alatom za
procjenu neposrednog odgovora na alergene posredovanog IgE ili drugih
mehanizmima u pacijenata aleričnih na lijekove. Do danas, većina studija o
degranulaciji bazofila u literaturi koristi CD69 ili CD203c kao markere za
kvantificiranje degranulacije bazofila nakon stimulacije specifičnim antigenom.
Abstract (english) Adverse drug reactions are a common clinical problem. The skin may be the only
organ affected or it may herald a more serious multiorgan reaction. The cutaneous
manifestations include a wide spectrum such as angioedema, macular, papular,
vesicular, bullous, vasculitic and hemorrhagic lesions. The first step is clinical
approach which includes detailed morphological diagnosis of skin symptoms and
signs, exclusion of danger signs and some basic laboratory tests. The morphological
diagnosis helps to establish a pathogenetic hypothesis.
A battery of drugs can be tested in vivo – prick, intradermal and patch tests, and
in vitro – whereby, because of low sensitivity of these tests, only positive tests are
relevant, while negative tests cannot rule out a sensitization.
Prick tests and intradermal tests are used to investigate immediate
hypersensitivity, patch tests and intradermal tests with delayed readings are helpful
for symptoms appearing delayed. Patch tests and prick tests can be done with any
commercialized form of a drug, intradermal tests normally rely on the availability of a
sterile solution used for parental applications.
Challenge tests, which are considered to be the gold standard, are frequently not
tolerated by the patients and bear the risk of severe reactions. In vitro tests have the
advantage of being a safe procedure for the patient and may provide insight into the
underlying pathomechanisms. They are often still a research tool, are not
standardized and fit only to certain type of drug allergies. To date, lymphocyte
transformation test is mostly used.
In recent years, the quantification of basophil activation by flow cytometry
(basophil activation test) has proven to be a useful tool for the assessment of
immediate-type responses to allergens mediated by IgE or other mechanisms in
drug-allergic patients. To date, most basofil activation test studies reported in the
literature have used CD69 or CD203c as markers to quantify basophil activation after
antigen-specific stimulation.
Keywords
neželjene reakcije na lijekove
in vivo testovi
in vitro testovi
Keywords (english)
adverse drug reactions
in vivo tests
in vitro tests
Language croatian URN:NBN urn:nbn:hr:105:132523 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2015-09-28 09:09:57
