Internal illnesses. Drug disease (diagnosis, complication, treatment) (most important)

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Internal illnesses. Drug disease (diagnosis, complication, treatment) (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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55. DRUG DISEASE (DIAGNOSIS, COMPLICATION, TREATMENT)

In a diagnostic study, skin tests are used:

1) in case of allergic reactions of immediate type: intradermal injection of an antigen is manifested by hyperemia and a blister at the injection site due to degranulation of mast cells and the release of inflammatory mediators;

2) in delayed-type allergic reactions, skin tests have no diagnostic value.

Application tests reveal sensitization to drugs for topical use only.

The level of specific IgE is determined with the production of a radioallergosorbent test or a histamine release reaction by mast cells.

Immunological determination of specific IgJ and IgM to drugs, fixed in tissues or circulating immune complexes (CIC) is performed.

To identify sensitized T-lymphocytes, the reaction of lymphocyte blast transformation (RBTL) is performed or cytokine production is evaluated. This method is more sensitive than RBTL.

Provocative tests allow you to establish a connection between the use of the drug and the occurrence of an allergic reaction. Due to the high risk of developing severe allergic reactions, samples are used very rarely, only in a hospital.

Complications. Allergy to drug metabolites, pseudo-allergic reactions.

Differential diagnosis. Should be carried out with the primary side effect of the drug, which develops when using drugs in therapeutic doses and is associated with their direct effect on target organs.

It is necessary to exclude the secondary side effect of the drug as a complication of drug treatment that is not associated with the direct effect of drugs on target organs.

It is necessary to exclude:

1) idiosyncrasy, a qualitatively altered response to the drug, due to non-immune mechanisms;

2) drug intolerance - the appearance of side effects when prescribing drugs in low doses;

3) toxic manifestations that develop with an overdose of the drug;

4) systemic lupus erythematosus;

5) vasculitis;

6) dermatitis, skin diseases.

Treatment. First of all, the drug that caused the allergic reaction is canceled.

With an allergic reaction of type I, epinephrine, H1-blockers are prescribed, with allergic reactions of types II, III and IV - corticosteroids.

Flow. depending on the type of allergic reaction. Recovery is complete.

Forecast. With an allergic reaction of type I in case of untimely resuscitation, the prognosis is unfavorable. With allergic reactions II, III and IV types - favorable.

Prevention. It is necessary to conduct a mandatory collection of an allergic history, to exclude drugs that often cause allergies.

Author: Myshkina A.K.

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