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1、DrugEruptionLiangchunWangDepartmentofDermatology,theSecondAffiliatedHospital,SunYat-SenUniversity09.3.20WhatisdrugeruptionTheadversedrugreactionsoftheskinWhydowehavetoknow?Over2MILLIONseriousADRsyearly100,000DEATHSyearlyADRs4thleadingcauseofdeathaheadofpulmonarydisease,diabe
2、tes,AIDS,pneumonia,accidentsandautomobiledeathsNursinghomepatientsADRrate—350,000yearlyWhydowehavetoknow?Gastrointestinaltractevents22.1%Electrolyte/renal16.7%Hemorrhagic12.7%Metabolic/endocrine9.5%Dermatologic(skin)/allergic7.9%CausesofdrugeruptionINGESTANTS:substancesthate
3、nterthebodybymouthINHALANTS:theallergenisbreathedinthroughthenoseormouthCONTACTALLERGIES:enterthebodythroughtheskinINJECTED:enterthebodythroughpuncturePathogenesisInmostpatternspathogenesisisUNKOWN1!PossiblemechanismsImmunologicmechanism-unpredictableNonimmunologicmechanisms
4、-sometimespredictableIdiosyncraticwithapossibleimmunologicmechanism-unpredictableImmunologicmechanism-unpredictableNonimmunologicmechanisms-sometimespredictableIdiosyncraticwithapossibleimmunologicmechanism-unpredictableResponsebythepatientstothedrugoritsmetaboliteFourtypeso
5、fhypersensitivityTypeIhypersensitivity(1)TypeIhypersensitivity(2)SystemicAnaphylaxis(Allergicshock)Anaphylacticshockdrugallergy,e.g.penicillintoxinfrombee,seafoodLocalizedAnaphylaxis:Breathetractallergy:allergicrhinitis,allergicasthmaDigesttractallergy(food)Skinallergy:urtic
6、aria,angioedemaTypeIIhypersensitivity(1)Redcells:Penicillin,chloropromazine,phenacetinGranulocytes:Quinidine,amidopyrinePlatelets:sulphonamides,thiazidesTypeIIhypersensitivity(2)InfusionreactionNeonatehemolysis(Rhbloodgroupantigen)Drugreactionshemolyticanemia,thrombocytopeni
7、cpurpura,granulocytopeniaGraves’diseaseTypeIIIhypersensitivity(1)InitiallydescribedfollowingadministrationoftherapeutichorseserumfortreatmentofpneumococcalpneumoniaNowdescribedfollowingcertaininfections,administrationofpenicillinandotherantibiotics,vaccines,andforeignprotein
8、sOnsetusuallyat7-10daysfollowinginjection,coincideswithswitchtoIgG,onsetat1
