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Unerwünschte Arzneimittelreaktionen an der Haut

Zwischen trivial und fatal

Adverse drug reactions and the skin – from trivial to fire signal

  • Schwerpunkt: Dermatologie für Internisten
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Zusammenfassung

Unerwünschte Arzneimittelwirkungen stellen ein häufiges medizinisches Problem dar. Insbesondere die Überempfindlichkeitsreaktionen sind wegen ihrer dosisunabhängigen, nicht vorhersehbaren Natur häufig beeindruckend und verunsichernd. Die klinischen Manifestationen an der Haut sind vielfältig und reichen von makulösen Exanthemen über bullöse Reaktionen zu Urtikaria und Angioödem bis hin zur Anaphylaxie. Aber auch systemische Hypersensitivitätsreaktionen unter Einbeziehung fast aller Organsysteme kommen vor. Charakteristische klinische Alarmzeichen für schwere allergische Arzneimittelreaktionen sowohl vom Sofort- als auch vom verzögerten Typ helfen, die Entwicklung einer allergischen Reaktion auf Arzneimittel frühzeitig zu diagnostizieren, die Zufuhr der potenziellen Allergene zu stoppen und therapeutische Maßnahmen einzuleiten. Entscheidend für die Aufarbeitung solcher Reaktionen im allergologisch-pharmakologischen Grenzgebiet ist die genaue Beschreibung und Dokumentation der Morphe der Hautreaktion und der exakten zeitlichen Abläufe der Medikamenteneinnahme. Dies erleichtert die Auswahl der adäquaten allergologischen Testverfahren und die Interpretation der Ergebnisse.

Abstract

Adverse drug reactions are a common medical problem. Especially hypersensitivity reactions are mostly impressive and unsettling due to their nature of being not dose-dependent and non-predictable. Clinical manifestations of the skin comprise manifold appearances from mild macular exanthems to bullous eruptions, and urticaria, angioedema to anaphylaxis. Systemic hypersensitivity reactions can affect nearly all internal organs and cells. Characteristic clinical danger signs for severe allergic drug reactions, for immediate type as well as for delayed type manifestations, help to recognise the incipient allergic drug reaction, to stop the further administration of the potential elicitor/allergen and to start therapeutic actions. It is essential for the success of a further allergologic work-up of such reactions to describe and document accurately the morphologic characteristics of the skin and other organ manifestations and the exact time course of medication intake and development of the clinical adverse reaction. This facilitates the choice of adequate diagnostic measures and the interpretation of the respective results.

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  1. Allergologische Poliklinik, Dermatologische Klinik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz

    K. Scherer &  A. Bircher

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  1. K. Scherer
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  2. A. Bircher
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Correspondence to A. Bircher.

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Scherer, K., Bircher, A. Unerwünschte Arzneimittelreaktionen an der Haut. Internist 50, 171–178 (2009). https://doi.org/10.1007/s00108-008-2210-0

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