Zusammenfassung
Arzneimittelüberempfindlichkeitsreaktionen betreffen über 7% der Bevölkerung und sind ein Problem für Patienten und Ärzte. Bei einem Teil solcher Reaktionen wurden IgE-vermittelte Mechanismen dokumentiert. Klinische Manifestationen von Reaktionen vom Soforttyp, die direkt nach Arzneimittelzufuhr (zumeist ≤1 h) auftreten, sind akute Urtikaria, Angioödem, Atemnot und andere Symptome der Anaphylaxie an Haut, Magen-Darm-Trakt, Atemwegen oder Kreislaufsystem. Arzneimittel führen in der überwiegenden Mehrzahl zu milderen Reaktionen, sind aber auch die häufigsten Auslöser fataler Anaphylaxien. Die mediane Dauer zwischen systemischer Zufuhr und klinischem Tod liegt dann bei etwa 5 min. Die wichtigsten auslösenden Arzneimittel sind Schmerzmittel, Antibiotika, Röntgenkontrastmittel und Muskelrelaxanzien. Ziel der anamnesegeleiteten Hauttestung und ggf. Labortestung ist der Nachweis einer Sensibilisierung, der in Abhängigkeit von dem auslösenden Arzneimittel nur bei weniger als der Hälfte der Fälle gelingt. Ansonsten ist häufig zur Klärung der Diagnose, d. h. zur Bestätigung oder zum Ausschluss einer Arzneimittelüberempfindlichkeit, eine Provokationstestung unter kontrollierten Bedingungen notwendig. Die Therapie besteht in der Meidung der auslösenden Arzneimittel, nur bei dringender Indikation wird eine Toleranzinduktion durch „Desensibilisierung“ durchgeführt.
Abstract
Drug hypersensitivity reactions affect more than seven percent of the population and are a concern for patients and doctors alike. In a substantial part of such reactions, IgE-mediated mechanisms have been documented. Clinical manifestations of immediate reactions, which occur directly after drug intake (mostly ≤ 1 h), are acute urticaria, angioedema, dyspnea and other symptoms of anaphylaxis in the skin, gastrointestinal tract, respiratory tract or cardiovascular system. Although normally leading to milder reactions, drugs are also the most frequent elicitors of fatal anaphylaxis. The median time interval between systemic drug application and clinical death is 5 min. The most common elicitors of immediate reactions are analgesics, antibiotics, radiocontrast media and muscle relaxants. The aim of history and experience guided skin tests ± laboratory tests is to document a sensitization, which depends on the eliciting drug and is only successful in less than half of the patients. Else a drug provocation test under controlled conditions is necessary to clarify the diagnosis and to confirm or exclude a drug hypersensitivity reaction. Therapy consists in drug avoidance or in pressing indications in tolerance induction by a “drug desensitization”.
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Interessenkonflikt. K. Brockow: Vortragstätigkeit für Thermo Fisher/Phadia. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Brockow, K. Arzneimittelreaktionen vom Soforttyp. Hautarzt 65, 409–414 (2014). https://doi.org/10.1007/s00105-013-2695-x
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DOI: https://doi.org/10.1007/s00105-013-2695-x