Zusammenfassung
Arzneimittelüberempfindlichkeiten machen etwa 25 % aller Nebenwirkungen auf Arzneimittel aus und lassen sich in allergische und pseudoallergische Arzneireaktionen differenzieren. Je nach Pathogenese und Klinik kann man anaphylaktische Sofort- und exanthematische Spätreaktionen verschiedenen klinischen Musters unterscheiden. Ihre diagnostische Abklärung beinhaltet eine umfassende, aber gleichermaßen auf die wichtigsten Parameter fokussierte Anamnese, Durchführung von Hauttests und ggf. Provokationstests sowie den möglichen ergänzenden Einsatz von In-vitro-Tests wie dem Basophilenaktivierungstest oder T‑zellulären Assays. Letztere können nicht nur wichtige zusätzliche Informationen liefern, sondern gerade im Fall sehr schwerer oder nicht durch Provokationstests weiter abklärbarer Arzneireaktionen entscheidende Befunde beisteuern. Ziele der Untersuchungen sind nicht nur der Nachweis einer Arzneimittelunverträglichkeit und die Detektion des auslösenden Medikaments, sondern auch die Aufdeckung des zugrunde liegenden Reaktionstyps und Identifizierung möglicher Alternativpräparate. All diese Informationen sind von hoher Bedeutung sowohl für eine fachkundige Beratung des Patienten als auch für die erforderlichen Präventivmaßnahmen zur Vermeidung erneuter Arzneimittelreaktionen.
Abstract
Drug hypersensitivity reactions comprise approximately 25% of all adverse drug reactions and can be classified into allergic and pseudoallergic drug reactions. Immediate type anaphylactic and delayed type rash reactions of various clinical patterns can be distinguished, depending on the pathogenesis and clinical symptoms. The diagnostic work-up encompasses a thorough but also focused evaluation of the medical history, skin tests and when indicated challenge tests. Furthermore, in vitro tests, such as basophil activation tests and T cell assays not only add valuable additional information but can also yield decisive results for the diagnosis, especially in cases of severe drug reactions or reactions which cannot be further clarified by provocation tests. The aim of these measurements is not only the proof of drug intolerance and the detection of the causal drug but also the disclosure of the type of adverse reaction and the identification of potential, tolerated alternative drugs. This information is very important for the counseling of the patient and for prevention of new drug hypersensitivity reactions in the future.
Abbreviations
- AGEP:
-
Akute generalisierte exanthematische Pustulose
- AM:
-
Arzneimittel
- AMÜ:
-
Arzneimittelüberempfindlichkeit
- BAT:
-
Basophilenaktivierungstest
- CAST:
-
„Cellular antigen stimulation test“
- DRESS:
-
„Drug rash with eosinophilia and systemic symptoms“
- EEM:
-
Erythema exsudativum multiforme
- ELISpot Assay:
-
„Enyzme linked immunospot assay“
- FACS:
-
„Fluorescence activated cell sorting“
- HRA:
-
Histamin-Release-Assay
- HSV:
-
Herpes-simplex-Virus
- HT:
-
Hauttest
- LTT:
-
Lymphozytentransformationstest
- PT:
-
Provokationstest
- SJS:
-
Stevens-Johnson-Syndrom
- TEN:
-
Toxisch-epidermale Nekrolyse
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C. Möbs und W. Pfützner geben an, dass kein Interessenkonflikt besteht.
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Möbs, C., Pfützner, W. Diagnostik von Arzneimittelüberempfindlichkeiten. Hautarzt 68, 19–28 (2017). https://doi.org/10.1007/s00105-016-3908-x
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DOI: https://doi.org/10.1007/s00105-016-3908-x