جستجوی مقالات مرتبط با کلیدواژه « Drug Allergy » در نشریات گروه « پزشکی »

Hypersensitivity to drugs is a group of adverse drug reactions whose side effects can even be fatal worldwide, and in most cases, despite the huge investments and extensive research that has been done in the production of drugs, it causes the drug to be discarded. Adverse drug reactions (ADRs) are generally divided into two categories: A and B. Type A reactions are predictable and dose-dependent, but type B adverse drug reactions are unpredictable and dose-independent, sometimes accounting for up to 20% of all adverse drug reactions, including severe drug allergies. It is due to the immune system (drug allergy) or reactions without immune intervention. ADRs of type A, also known as adverse pharmacological drug reactions, occur for two reasons: the first, dose changes or pharmacokinetics that cause changes in reactions related to efficacy or detoxification. The second, a change in the structure of the target that leads to a change in the drugchr('39')s propensity for it or to a new flow of reactions due to the binding of the agonist to the target receptor. In contrast, adverse drug reactions of type B are caused by severe drug allergies due to allergenic or non-allergenic mechanisms of the immune system or its mediators such as histamine. The molecules of the major histocompatibility complex (MHC) are one of the most important factors in how and what is the variety of immune responses in different people. Numerous studies have reported the association of some variants of these molecules in the presence and absence of certain diseases, including malignancies and autoimmune diseases. Over the past decade, several studies have been performed on the association of MHC or HLA alleles with drug hypersensitivity syndromes (DHS), which promises to be able to diagnose and identify high-risk patients and thus may prevent the development of DHS, which seemed previously unpredictable. In 1989, a study was performed on patients in southern China taking allopurinol for skin rashes, with a strong positive association between HLA alleles, class AW33 and B17/BW58, and a negative association with the A2 allele. These findings indicate that the genetic background in dermal drug reactions is associated with and not associated with some MHC class I and II molecules. In 2007, the Food and Drug Administration (FDA) recommended a screening test to determine the HLA-B*15:02 allele in high-risk populations before carbamazepine. In 2011, a genome-wide association study (GWAS) of the Nordic and Japanese populations found that the Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic (DRESS) diseases observed in carbamazepine-associated patients were associated with the 31:01 HLA-A*allele. In 2013, a study of black African populations reported the association of the HLA-C*04:01 allele with SJS/TEN and the HLA-DRB1*01:02 and HLA-B*58:01 alleles with Nevirapine-induced hepatitis. In 2015, researchers applied chemical modifications using in silico methods to abacavir to create a molecule that retains its antiviral activity; meanwhile, being able to bind to HLA-B57: 01 and activate T cells. In 2018, a study was performed on the Taiwanese and Malaysian populations on the association of HLA-B*13:01 allele with severe cutaneous adverse drug reactions (SCAR) induced by dapsone antibiotic, which showed a positive association of this allele with DRESS phenotype. In 2019, a study of variants predisposing individuals to drug-induced liver injury (DILI) found that a missense polymorphism that causes tryptophan to be replaced by arginine in the PTPN22 gene was most associated with this phenotype and strongly associated with DILI due to the use of the antibiotic co-amoxiclav in patients with European ethnicities, and the probability of developing DILI in this population is twice as high in people who, in addition to the mentioned polymorphisms, are also carriers of HLA-A*02:01 and DRB1*15:01 predisposing alleles. Genetic differences in different races necessitate these studies in different populations and countries. Therefore, based on a review of the literature, we suggest that these studies should be performed in the Iranian population, especially in allergic diseases.

Drug reactions are common and can be dangerous. Regarding the points that there wasn’t any study in this field in the Yazd University of Medical Sciences, this study was planned.

In a retrospective descriptive study, records of patients who were admitted in Shahid Sadoughi hospital (an educational general hospital) due to drug reaction from 2011 to 2015 were evaluated. Patient’s information such as gender, age, occurred drug reaction, duration of hospital stay and the time of drug reaction after drug usage completed in the data form collection. Diagnosis was confirmed by an allergist based on the history, physical examination and laboratory tests in patient’s hospital documents.

From 154 cases which admitted with adverse drug reaction, 77 cases (50%) were related to drug allergies and 13 (4.8%) were drug complications and 64 cases (41.6%) were drug toxicity. 78 patients were male (50.6 percent) and 76 (49.4%) patients were female. 64 patients (41.6%) were less than 6 years and 28 patients (18.2%) were 6 to 14 years and 62 patients (40.3%) were   more than 14 years. Drug allergies were categorized to Gell and Combs classification in type Ι, 12 patients (16.7%), type II no case, type III, 9 patients (12.5%) and type Ⅳ, 56 patients (78%). Antiepileptic drugs were the most common causes of drug reactions (31.2%) of which, lamotrigine had the highest percentage (15.6%). Finally, five deaths were reported due to the drug reaction.

Adverse drug reactions were common and remarkable in Shahid Sadoughi hospitals and from 2011 to 2014 its prevalence had increased. Patients and physicians must be aware of adverse drugs reactions. Warning signs of adverse drugs reactions should be noted to the patients and their families. Reduction in the consumption of medication without prescription may also be useful in preventing drug reactions.