Drug Hypersensitivity in Daily Practice

Gatot Soegiarto

Abstract

ABSTRACT

Adverse drug reactions can affect up to 25% of outpatients and 10–20% of hospitalized patients. They are an important public health issue due to the potential of fatal outcomes. They are increasingly common in daily practice, but ascertaining whether the adverse reaction is a true allergic reaction to the drug is not easy. Drug hypersensitivity encompasses a spectrum of immunologically and non-immunologically-mediated reactions with varying mechanisms and clinical presentations. Factors associated with an increased risk of developing a drug hypersensitivity include patient-related factors, treatment regimen-related factors, and drug-related factors.  Diagnosis of drug hypersensitivity relies on a careful history and physical examination and, in some instances, in vivo and in vitro testing and drug provocation tests. The most effective strategy for the management of drug allergy is avoidance and discontinuation of the offending drug(s). Alternative medications with unrelated chemical structures should be given. Additional therapy is largely supportive which includes nutritional support, fluid replacement, and symptomatic which may include topical corticosteroids, oral antihistamines and, in severe cases, systemic corticosteroids. This article will discuss the classification of adverse reactions to drugs, professional steps that can be taken by a physician in prescribing drugs, minimizing the risk of adverse drug reactions, approach to diagnosis, and managing drug hypersensitivity cases in daily practice.

Keywords: drug reaction, drug hypersensitivity, drug allergy

Correspondence to: gatotsby@yahoo.com

 

ABSTRAK

Reaksi efek samping obat dapat mengenai sekitar 25% pasien rawat jalan dan 10-20% pasien rawat inap. Reaksi efek samping obat adalah masalah kesehatan masyarakat yang penting karena berpotensi fatal. Hal tersebut semakin umum dijumpai dalam praktek sehari-hari, tetapi memastikan apakah reaksi efek samping tersebut adalah reaksi alergi yang sebenarnya terhadap obat itu tidaklah mudah. Hipersensitivitas obat mencakup spektrum reaksi yang dimediasi secara imunologis dan non imunologis dengan berbagai mekanisme dan presentasi klinis. Faktor-faktor yang terkait dengan peningkatan risiko terjadinya hipersensitivitas obat meliputi faktor terkait pasien, faktor terkait regimen pengobatan, dan faktor terkait obat. Diagnosis hipersensitivitas obat bergantung pada anamnesis dan pemeriksaan fisik yang cermat dan, dalam beberapa kasus, tes in vivo dan in vitro dan tes provokasi obat. Strategi yang paling efektif untuk pengelolaan alergi obat adalah penghindaran dan penghentian obat-obatan tersebut. Obat-obatan alternatif dengan struktur kimia yang tidak terkait harus diberikan. Terapi terapi suportif yang mencakup dukungan nutrisi, penggantian cairan, dan gejala yang mungkin termasuk kortikosteroid topikal, antihistamin oral dan, dalam kasus yang parah, kortikosteroid sistemik dapat diberikan. Artikel ini akan membahas klasifikasi reaksi efek samping terhadap obat, langkah profesional yang dapat diambil oleh dokter dalam meresepkan obat, meminimalkan risiko reaksi efek samping obat, pendekatan untuk diagnosis, dan manajemen kasus hipersensitivitas obat dalam praktik sehari-hari.

Kata kunci: Reaksi obat, hipersensitivitas obat, alergi obat

Korespondensi: gatotsby@yahoo.com

Keywords

Immunology, Medicine, Drugs

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DOI: http://dx.doi.org/10.30651/jqm.v3i2.2781