Internal illnesses. Drug disease (most important)

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Internal illnesses. Drug disease (most important)

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54. DRUG DISEASE

Drug disease is associated with the production of antibodies or the appearance of T-lymphocytes specific for the drug or its metabolites.

Causes of development include repeated use of intolerable drugs.

Ways of formation

There are 5 types of drug allergic reactions based on the classification of F. Gell and R. Coombs (1964):

1) anaphylactic: sensitization of the body is associated with hyperproduction of cytophilic IgE, which is quickly fixed by the Fc fragment on tissue basophils - mast cells, and to a lesser extent on eosinophils and other cells; this is accompanied by a low concentration of IgE in plasma;

2) cytotoxic: sensitization is characterized by the production of antibodies against antigens that are direct or secondary components of cell membranes; antibodies are IgJ, less often - IgM;

3) immunocomplex: occurs when pathogenic circulating immune complexes (CIC) appear in the plasma;

4) cellular (delayed-type hypersensitivity): occurs on allergens that are part of large molecules, which are then phagocytosed by macrophages, without damaging antigenic determinants;

5) immunological stimulation: is a variant of the type 2 reaction, develops when antibodies to cell receptors appear.

Clinical manifestations. Allergic reactions of immediate type. Caused by many drugs, most often penicillins, develop within 30 minutes after drug administration. Urticaria, Quincke's edema, bronchospasm, anaphylactic shock appear. Rarely, with the introduction of penicillins, Stevens-Johnson syndrome, Lyell's syndrome, interstitial nephritis, systemic vasculitis, hemolytic anemia, neutropenia, neuritis can develop.

Cytotoxic allergic reactions. With this form, hematological disorders develop: autoimmune hemolytic anemia, thrombocytopenia, agranulocytosis. The kidneys are affected: with interstitial nephritis caused by methicillin, antibodies appear to the basement membrane of the renal tubules.

Immune complex allergic reactions. Most often caused by penicillins, heterologous serums. Symptoms of serum sickness usually appear 1-3 weeks after administration of the serum. Urticaria, maculopapular rash, fever, arthralgia (large joints) develop, lymph nodes may enlarge, glomerulonephritis, peripheral neuropathy, systemic vasculitis, acute inflammatory demyelinating polyradiculoneutropathy may occur. It is possible to develop drug-induced lupus syndrome, vasculitis with symptoms of fever, hemorrhagic rash, often on the legs, with damage to the kidneys and lungs.

Allergic reactions of the delayed type.

These include allergic contact dermatitis (after topical use of drugs), acute pneumonitis, interstitial pneumonitis, encephalomyelitis, interstitial nephritis, drug-induced hepatitis, and vasculitis. Acute and interstitial pneumonitis is characterized by fever, shortness of breath, cough, eosinophilia, limited or extensive opacities in the lungs, pleural effusion, and respiratory failure.

Author: Myshkina A.K.

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