3/25/2014

1
DNG THUOC DNG THUOC
Drug al l ergy
Al l ergi e medi camenteuse
PGS. TS. Nguyn Tun Dng
AP NG MI EN DCH ( Ag Ab )
DNG THUOC
BI EU HI EN LAM SANG &
CAC LOAI DNG (Type I ,I I ,I I I ,I V)
PHONG NGA & I EU TRDNG THUOC
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AP NG MI EN DCH
HE
MI EN DCH
kn
ap ng ung mc ap ng ung mc
ap ng kem ap ng kem
ap ng quamc ap ng quamc
Mien dch tnhien
Hang rao vat l y da vani em mac
Hang rao hoa hoc ac. l acti c, ac. beo,
l ysozyme, nc mat,
nc mui , nc bot,
Hang rao tebao khanang thc bao
Mien dch thu nhan ( chuyen bi et )
THEDCH THEDCH : Lym pho B (tuy xng)
TRUNG GI AN TEBAO : TRUNG GI AN TEBAO : Lym pho T (tuyen c)
Mi en dch tnhi en & thu nhan
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ng xam nhap cua cac tac nhan
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Thuc / nhm thuc no c t
l gy d ng cao nht ?
11,6%
6,5%
4,0%
3,4%
1,3%
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Khang nguyen Khang the
Khang nguyen Khang the
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Benzylpenicillin
Benzylpenicillenic acid
NH
2
+
Benzylpenilloic acid
Benzylpenamaldic acid
Tissue
protein
Major haptemic
determinant
Tissue
protein
S - S
95% 5%
Minor haptemic
determinant
Formation of the benzyl penicilloyl hapten-protein complex
(Stafford C.T. Medical Times 1988)
NH
Serum Protein Electrophoresis Serum Protein Electrophoresis
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Ag & Ac
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DNG THUOC
ac iem cua dng thuoc
Tyl erat thap
Khong l i en quan en tac dung dc l y
Khong phuthuoc vao l i eu
Hi em khi xuat hi en l an au
Phan ng cheo (cr oss r eacti vi ty)
Tang bach cau a aci d
Chuyen bi et vi mot sol oai thuoc
phan ng bi en mat khi ngng thuoc
Tng bch cu a acid
Suy thng thn (Adison)
Eczema
Hen suyn
Vim ng tiu ha (Eosinophilic gastroenteritis)
Nhim k sinh trng
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BI EU HI EN LAM SANG
Tacongtongthe(mul ti system i nvol vement)
Soc phan ve anaphyl axi s Peni ci l l i n, san pham tmau, hormon
pol ypepti d, vacci n, dextran
Benh huyet thanh ser um si ckness Sul f onami des, hydantoi nes, peni ci l l i nes,
cephal ospori nes
Sot do thuoc dr ug fever Methyl dopa, procai nami de, phenytoi n,
barbi turi c, qui ni di n, khang si nh
Tmi en nhi em
do thuoc
Dr ug-i nduced
autoi mmuni ty
Hydral azi ne, procai nami de, i soni azi d,
methyl dopa
Vi em mach vascul i ti s Al l opuri nol , -l actam, sul f onami des,
Tacongtrencquan
Tren da
Hohap
Huyet hoc
Tren gan
Tren than
Tren tebao l ympho
may ay
hen suyen
tang bach cau a aci d
vi em gan, mat
vi em cau than
u bach huyet
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C CHE PHAN LOAI
( Gel l & Coombs )
PHAN NG
MAN CAM
TYPE I
(anaphylact ic)
TYPE I I
(cyt ot oxic)
TYPE I I I
(immune complex)
TYPE I V
(cell mediat ed)
TRI EU
CHNG
KHI PHAT
Nhanh
< 30 phut
Nhanh
5 12 gi
Nhanh
3 8 gi
Cham
24 48 (gi)
PHAN NG
TRUNG GI AN
Thedch
(I gE)
Thedch
(I gG,I gM)+ bothe
Thedch
(I gG)
Tebao
DI EN BI EN
PHAN NG
Phong hat tte
bao Mast
Phan ng gia
KH KT
Ket tua phc hp
mien dch
Hoat hoa
Lympho bao
Phong thch
chat
TGHH
Hoat hoa bothe * Hoat hoa bothe
* KT tebao tr ung
tnh
* Phan ng viem
San xuat
Lymphokin
BI EU HI EN
LAM SANG
HaHA
Co c tr n
Soc P. ve
Huy tebao
(cytolyse)
Ton thng mo
(enzym lysosom)
Conh ai
thc bao
Tr uyen mau
Thieu mau tieu
huyet
Benh huyet thanh Quaman do
tiep xuc
C CHE PHAN LOAI ( tt )
( Gel l & Coombs )
PHAN NG
MAN CAM
TYPE I
(anaphylacti
c)
TYPE I I
(cytotoxic)
TYPE I I I
(immune
complex)
TYPE I V
(cell
mediated)
Cac tac nhan
gay dng
Penicillin
Hor mon
Dextr an
Penicillin
Quinidin
Thiour acil
Penicillin
Sulfonamid
Hydantoin
Penicillin
Phan ng
tuber culin
S.pham t
mau
Sulfonamid
Methyldopa
Phenyl-
butazone
Chat can
quang
Ghep c
quan
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Type I - Phan ng ki eu phan ve(anaphyl acti c) (anaphyl acti c)
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Le Mastocyte Le Mastocyte
Mdiateurs prforms
HISTAMINE HISTAMINE
Mdiateurs noforms
PAF, prostaglandines, LT, ...
Noi meay
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Somui
ng mat
suyen
Type I I - Phan ng oc tebao (cytotoxi c) (cytotoxi c)
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Nhom mau ABO
Phan ng truyen mau
Phan ng ti eu huyet tres si nh
Yeu toRhesus
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Type I I I - Phan ng tao phc hp mi en dch
(i mmune compl ex) (i mmune compl ex)
Hoahng ong
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Type I V - Phan ng cham (cel l medi ated) (cel l medi ated)
Eczema
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Da au, l o
tai
Dau goi oau, thuoc nhuom toc, knh eo
mat
Mat Mypham, thuoc chong nang, thuoc trmun
(benzoyl peroxyd), thuoc cao rau
Co Vong eo co, nc hoa
Lng Thuoc thoa tai cho, thuoc chong nang,
Nach Thuoc khmui ,
Tay Savon, thuac tay gi ac, xi mang, nhan, vong
eo tay, gang, thuoc thoa tai cho, ong ho
Dng vi em da do ti ep xuc
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Para-phenylenediamine
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C a d ng vi PPD cng c th gy d ng C a d ng vi PPD cng c th gy d ng
cho vi cc nhm sau cho vi cc nhm sau :
- Thuc nhum tc azo hay anilin.
- Mt s loi thuc t, thuc m:
benzocain,procain.
- Para-aminobenzoic acid (PABA)
- Para-aminosalicylic acid
- Sulfonamide, sulfones
- Carbutamide
Test phat hi en dng
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Mot soth duvetest
phat hi en dng
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YEU TONGUY C
Yeutolien quan entrlieu
Ban chat cua thuoc
Phan ng cheo
ng sdung T
Cach sdung
cau truc, trong l ng PT
aspi ri n & NSAI D
dung ngoai , dang ti em..
Dung thuoc keo dai /ngat quang
Yeutolien quan enngi benh
Tuoi
Gi i
Yeu todi truyen
Ti en s& c a
Conhi eu benh
sdung nhi eu thuoc
Thuoc sdung trc o
treem < ngi l n
khong phuthuoc vao gi i
cokhanang l i en quan en di truyen
Nhay cam vi tac nhan
Nguy c bdng cao hn
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PHONG NGA & I EU TR
Nguyen tac chung
Cach l y dnguyen, ngng & tranh sdung
nhng thuoc gay dng
i eu trtri eu chng : khang hi stami n, corti coi d
Bunc vai en gi ai (trong trng hp mat
nc vai en gi ai )
Chong boi nhi em (neu co), chuyl a chon
khang si nh thch hp eam bao an toan
Gi ai man cam
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THUOC
C CHE
TAC ONG
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SOC PHAN VE
Phan ve(ana/phyl axi e) :
khong c bao ve
ngc l ai vi bao ve
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Socphan velien quan en I gE
Khang si nh
Thuoc khac
Protei n
Hormon
Enzyme
I gA
Thc an
Con trung
Peni , Cepha, Sul f ami d, Tetra.
Thuoc dan c, thi opental , protami n
Huyet thanh nga
ACTH, i nsul i n,...
trypsi n, papai n, streptoki nase
Truyen mau
au phong, au nanh
Ong vove, ruoi trau,
Socphan velien quan en phchpmiendch
Mau, hong cau, bach cau ...
Huyet tng
Mang ban tham cel l ul ose dung trong tham tch mau
Nguyen nhan
SOC PHAN VE( tt )
Nguyen nhan
Dng kieu soc phan ve
Do sbat thng / chuyen hoa ac. arachi doni c:
Aspi ri n, NSAI D
Tac ong trc ti ep tren tebao mast : opi um va
DX, thuoc dan c, khang si nh (pol ymi ci n...),
dextran, chat can quang, ...
Tac nhan vat l y,
Chat phugi a : sul fi t, gl utamat,
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SOC PHAN VE( tt )
Bi eu hi en l am sang
Xuat hien trong vong 30 phut sau khi dung thuoc
DA
MAT
MUI
HAU
PHOI
TI M MACH
TI EU HOA
THAN KI NH
nga ngay, omat, noi meay
nga, chay nc mat, omat
chay nc mui , hat hi , nghet mui
phu, khan ti eng, thrt
thgap, thkho, ti eng ran rt,...
ti m ap nhanh, l oan nhp tut HA
non ma, co rut, ti eu chay
shai , cam thay mui ki m l oai ,
choang vang, ngat, co gi at,
Tran ngap Tran ngap
Catechol ami n noi Catechol ami n noi
si nh trong c the si nh trong c the
* Gi am oxy trong dch ke
* Tch tuaci d l acti c
* Phong thch hi stami n
Ngan can ng dan
mau tnh mach quay tr
veti m
Truy ti m mach Truy ti m mach
Gi am tuan hoan gan Gi am tuan hoan gan
Gi am l u l ng than Gi am l u l ng than
Phong thch enzyme gay Phong thch enzyme gay
phan gi ai protei n phan gi ai protei n
vaphahuy thanh mao vaphahuy thanh mao
mach mach
Co that c vong Co that c vong
(ti en mao (ti en mao
mach) mach)
ong c vong ong c vong
(hau mao (hau mao
mach) mach)
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Yeu tonguy c phan ng soc phan ve
Hen suyen Thng l am cho phan ng soc phan ve
trnen tram trong hn
Ngi l n tuoi Nhay cam hn vi phan ng vanhat
l avi mot sothuoc can quang, khang
si nh.
Thuoc ket hp Chen , c chemen chuyen, c che
kenh cal ci .
Hormon nga thai
Dch tehoc phan ng phan ve
Peni ci l l i ne 1/100 Phan ng dng nhe
1/2500 Phan ng dng nghi em trong
USA 400-800 tvong / nam
Thuoc
can quang
1/200 Phan ng dng nhe
1/2200 Phan ng dng nghi em trong
USA # 40 tvong / nam
Vacci n 0.11- 0.31ca / 100.000 l i eu vacci n sdung
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Cc thuc c phn ng cho Cc thuc c phn ng cho
vi Opioid ? vi Opioid ?
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SULFONAMIDE DERIVATIVES
CLASSIFICATION CLASSIFICATION SPECIFIC DRUGS SPECIFIC DRUGS
Antimicrobial Sulfadiazine,
Sulfamethoxazole (ie, Bactrim and Co-trimoxazole

)
Carbonic Anhydrase Inhibitor Acetazolamid (Diamox
)
Diuretic, Loop Bumetanide (Bumex

),
Furosemide(Lasid

)
Torsemide (Demadex

)
Diuretics, Thiazide Chlorothiazide (Diuril

), Chlorthalidone (Anhydro

)
Hydrochlorothiazide (various and combinations, eg, Diazide

,
Maxzids

)
Hypoglycemic Agents, Oral Acetohexamide (Dymelor

),
Chlorpropamide (Diabinese

)
Glimepiride (Amaryl

), Glipizide (Glucotrol

)
Glyburide (Diabeta

, Glynase

, Micronase

)
Tolbutamide (Orinase

, Tol-Tab

)
Other Agents Celecoxib (Celebrex

)
Sulfasalazine (Azulfidine

)
I EU TR
Ti em 0,5 1 ml
adrenal i n 1mg/ml (1:1000)
ng tnh mach, di da
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I EU TR
Ti em 0,5 1 ml
adrenal i n 1mg/ml (1:1000)
Ti ep tuc ti em adrenal i n cach khoang 10-20 phut en
khi tnh trang benh nhan c cai thi en
Cothe dung adrenal i n tac dung keo dai di dang
dch treo 1/200 hay Adrenal i n tan / dau
1 2mg/ml
Pha l oang Adrenal i n trong dung dch Gl ucose 5%
(4g/ml ),
I EU TR
Phan l i eu adr enal i n theo tuoi
2 en 6 thang
12 thang
18 thang en 4 tuoi
5 tuoi
6 en 9 tuoi
10 en 13 tuoi
> 14 tuoi
0,07 ml
0,1 ml
0,15 ml
0,2 ml
0,3 ml
0,4 ml
0,5 Ml
0,07 mg
0,1 mg
0,15 mg
0,2 mg
0,3 mg
0,4 mg
0,5 mg
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Dung cuAna-Ki t sudung trong Cap cu
Dung cucap cu canhan Epi Pen
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Cc dng s dng ca
Adrenalin trong iu tr sc
phn v ?
I EU TR
Di phenhydrami n 25 100 mg p.o., i M, I V,...
l ap l ai moi 4 6 gi
Methyl predni sol one 2mg/Kg hoac 125 250 mg
I V moi 6 gi (ngan nga phan ng cham)
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I EU TR
Thut ra daday :
Trng hp nghi ngl oai thc an hay l oai thuoc
nao gay ra dng
Trng hp tnh trang benh nhan c cai thi en
cham
I EU TR
i eu trtri eu chng :
Chong co that
phequan
Sal butamol 0,5cm
3
/4cm
3
NaCl 0.9%
Ami nophyl l i n
Thong kh quan
Chong phune
hong
Adrenal i n dang kh dung
Thong noi kh quan
Thuthuat mthong kh quan