Drug allergy

약물 알레르기(Drug allergy)

분류

Immunologic drug reaction(drug allergy)

Skin test로 진단

• Anaphylaxis: Penicillin(m/c), cephalosporin, insulin
• Immune Complex: serum sickness
• Cytotoxicity & delayed hypersensitivity: SJS, TEN, Drug-induced hypersensitivity syndrome

Nonimmunologic drug reaction

유발 검사로 진단

• Pseudoallergy(anaphylactoid): opioids, radiocontrast media
• Idiosyncrasy(unknown reason): aspirin, NSAIDs, quinidine induced drug fever
  • Aspirin/NSAIDs 과민성
    • cross-reactivity를 보이는 약제: Ibuprofen, Indomethacin, Naproxen, Fenoprofen, Mefenamic acid, Phenylbutazone
    • 대체 약물: COX-2 inhibitor(celecoxib), acetaminophen 등

Non-immediate reactions without systemic involvement

• 6~10일 후 혹은 두번째 노출 후 3일 이내 발생
• maculopapular rash

진단

• 경구유발검사: asprin, NSAID, sulfite
• skin test(첩포, 피내 검사 등): penicillin, cephalosporins, insulin 등
• RAST

치료

• 원인 약제 중단(TOC)
• 대증 치료: antihistamine, steroid
• 대체 약물
  • aspirin: celecoxib, acetaminophen
  • penicillin: vancomycin, monobactam
• 탈감작: penicillin, insulin 등