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1、DrugEruptionLiangchunWangDepartmentofDermatology,theSecondAffiliatedHospital,SunYat-SenUniversity09.3.20WhatisdrugeruptionTheadversedrugreactionsoftheskinWhydowehavetoknow?Over2MILLIONseriousADRsyearly100,000DEATHSyearlyADRs4thleadingcauseofdeathaheadofpulmonarydiseas
2、e,diabetes,AIDS,pneumonia,accidentsandautomobiledeathsNursinghomepatientsADRrate—350,000yearlyWhydowehavetoknow?Gastrointestinaltractevents22.1%Electrolyte/renal16.7%Hemorrhagic12.7%Metabolic/endocrine9.5%Dermatologic(skin)/allergic7.9%CausesofdrugeruptionINGESTANTS:s
3、ubstancesthatenterthebodybymouthINHALANTS:theallergenisbreathedinthroughthenoseormouthCONTACTALLERGIES:enterthebodythroughtheskinINJECTED:enterthebodythroughpuncturePathogenesisInmostpatternspathogenesisisUNKOWN1!PossiblemechanismsImmunologicmechanism-unpredictableNon
4、immunologicmechanisms-sometimespredictableIdiosyncraticwithapossibleimmunologicmechanism-unpredictableImmunologicmechanism-unpredictableNonimmunologicmechanisms-sometimespredictableIdiosyncraticwithapossibleimmunologicmechanism-unpredictableResponsebythepatientstothed
5、rugoritsmetaboliteFourtypesofhypersensitivityTypeIhypersensitivity(1)TypeIhypersensitivity(2)SystemicAnaphylaxis(Allergicshock)Anaphylacticshockdrugallergy,e.g.penicillintoxinfrombee,seafoodLocalizedAnaphylaxis:Breathetractallergy:allergicrhinitis,allergicasthmaDigest
6、tractallergy(food)Skinallergy:urticaria,angioedemaTypeIIhypersensitivity(1)Redcells:Penicillin,chloropromazine,phenacetinGranulocytes:Quinidine,amidopyrinePlatelets:sulphonamides,thiazidesTypeIIhypersensitivity(2)InfusionreactionNeonatehemolysis(Rhbloodgroupantigen)Dr
7、ugreactionshemolyticanemia,thrombocytopenicpurpura,granulocytopeniaGraves’diseaseTypeIIIhypersensitivity(1)InitiallydescribedfollowingadministrationoftherapeutichorseserumfortreatmentofpneumococcalpneumoniaNowdescribedfollowingcertaininfections,administrationofpenicil
8、linandotherantibiotics,vaccines,andforeignproteinsOnsetusuallyat7-10daysfollowinginjection,coincideswithswitchtoIgG,onsetat1
