Medicinal illness

Medicinal disease is a manifestation of hypersensitivity to drugs or individual intolerance of drugs. There are two forms of drug diseases: 1) drug Allergy is the main, most common form; or the medicine itself, or the products of its transformation associated with serum or tissue proteins of the body and form a full antigen, causing the formation of allergic antibodies; 2) idiosyncrasy, develops due to genetically caused defects enzymes, metabolizing entered a drug. Often this enzyme defect promotes the development and allergic reactions. From drug disease should be distinguished other types of reactions caused by drugs (toxic effect due to overdose, side effects of drug treatment, such as candidiasis in patients receiving antibiotics).
Manifestations of drug disease is varied. Can affect all organs and body systems. Drug disease can be divided by the speed of development and flow into 3 groups: 1) reactions, developing instantly or within one hour after getting drugs into the body and the proceeding, as a rule, acute anaphylactic shock (see Anaphylaxis), urticaria (see), Kwinke swelling (see), bronchial asthma (see), haemolytic anaemia (see); 2) reaction subacute types occur within the first day after the drug: agranulocytosis and thrombocytopenia (see), system purpura nervosa (see Vasculitis, hemorrhagic), fever, allergic rhinitis; 3) reaction of the later type, developing in a few days and weeks after drug administration: serum sickness (see), allergic vasculitis and purpura, allergic dermatitis, inflammatory processes in the joints, lymph nodes and internal organs (allergic hepatitis, nephritis, encephalomyelitis). In addition, drug-disease manifests a relapse of the main disease. The most dangerous acute manifestations of drug diseases.
Essentially any medicine can be an allergen, i.e. may cause sensitisation of the body and the development of drug diseases. However, different drugs this ability is expressed in different ways. At repeated courses of treatment of the same drug, especially with the introduction of antitoxic serum, frequency of drug diseases, as a rule, increases. Medical and pharmacy workers manifestations of drug Allergy there are three times more likely than the rest of the population.
The diagnosis is easily put, if medicinal the disease started immediately after taking the medication. In other cases, you need to carefully collect the medical history of the patient. Do not use skin tests for diagnosis of drug disease. Introduction to skin the most minimal amounts of drugs such as antibiotics, in sensitive patients can cause anaphylactic shock. The diagnosis is confirmed, if after drug withdrawal symptoms drug disease pass.
Treatment. To discontinue the infusion, and with the rapid development of drug diseases to stop further entering of allergen into blood; if the medicinal disease caused by subcutaneous or intramuscular injection of medication, if possible, to put a tourniquet above the place of injection. In the place of injection immediately introduce 0.5 ml of 0.1% solution of adrenaline. In shock subcutaneously to enter 0.5 ml of 0.1% solution of adrenaline, and in severe cases, intravenous in 10-20 ml of 40% glucose solution. If blood pressure is not available, the introduction of adrenaline to repeat. In the absence of improvements to drip intravenous norepinephrine (5 ml of 0.2% solution diluted in 500 ml of 5% glucose solution and introduce with the speed 40-50 drops per 1 min). Events bronchospasm introduced slowly intravenously 10 ml of 2.4% solution of aminophylline.
In all manifestations of the rapidly developing drug disease, especially in skin, injected intramuscularly antihistamines: 1-2 ml of 2.5% solution of pipolfen, or 1 to 2 ml of 2% solution suprastin (can be carefully intravenously), or a 5 ml of 1% solution of Dimedrol. Subacute or late medicinal disease is best treated with corticosteroids (prednisolone, triamcinolone, dexamethasone, hydrocortisone-acetate) oral or intramuscularly. With proper treatment, the prognosis is good.
Prevention. Measures of the General order: 1) not to prescribe drugs where there is no need for this (for example, antibiotics flu); 2) do not administer intravenous injection, where enough intramuscular or subcutaneous; 3) the first injection of drugs, especially antibiotics, to do in the area of the shoulder, so that in case of acute drug disease could be applied in a harness proximal injection; 4) in the treatment rooms have a separate syringe and needle for each group of related chemically antibiotics; to eliminate the habit to remove excess fluids from the syringe straight up into the air, as this leads to dissipation of medications that can contribute to sensitization of health workers and patients and cause the development of drug diseases; 5) patients with allergies to medicines not to place in the house next to patients receiving these drugs. Individual prevention: 1) to ask the patient whether they had received the drug before, and as he moved his admission; 2) to determine if the patient suffers any allergic diseases, as these patients are more likely to develop drug disease; 3) to make a mark in history about Allergy to the drug; 4) to warn the patient that in the future did not take this drug.

Medicinal disease [morbus medicamentosus; synonym drug Allergy (allergia medicamentosa)] - manifestations of sensitization to one or the other drug in individuals with high immunological reactivity. In a basis of medicinal diseases like allergies (see) in General, is the reaction medication - antigen specific antibody.
Simple chemicals can directly or to act as antigens (A. M. Besedka, 1928) and as haptens [after connection with whey protein in complex antigens, Landsteiner (K. Landsteiner)], or modify the antigenic properties of the tissues of the body by damage to the cellular elements. Medicines with allergenic properties, are derivatives of benzene and pyrimidine with the side chains NH2, NO2 , etc.
Drug Allergy, as well as any other, is shown by the reactions of two types: 1) immediate "Valdarno", or anaphylactic response to the presence in the blood serum of specific antibodies (reagin), find different immunological methods - agglutination serum of patients suspension indifferent particles loaded with antigen; precipitation and so on; 2) time-lapse, "tuberculin reaction of cellular hypersensitivity with the clinical syndrome of erythema ninth day". For the reaction of the second type is characterized by the formation of intradermal granulomas on medication (antigen) in the absence of circulating antibodies. The presence of cell antibodies can be shown in the experience with the migration of lymphocytes and other sophisticated methods. Drug Allergy to a specific drug may be immediate "Valdarno", or anaphylactic, reaction followed by the development of granulomas, vasculitis, and so on, as is the case when serum sickness with which the medicinal disease has many other analogies.


Drug Allergy has become more common due to the wide use of vysokopatogennym drugs - arsenobenzene causing if you are hypersensitive nitritoid crises, hemorrhagic encephalitis and other; amidopirina (piramidon), the famous "provocateur" agranulocytosis; mercury diuretics that cause allergic hemorrhagic vasculitis; sulfonamides with complications, such as acute hemolysis, vasculitis, up to of periarteritis nodosa; penicillin, thiouracil, butadiona, PAS and other
Clinical manifestations L. B. are well known to doctors drug rash, drug fever (a"paradoxical" fever of the intolerance of quinine), drug arthritis and others, as well as unexpected as if wanton death from shock (for example, immediately after lubrication of the tonsils regular solution of silver nitrate). E. A. Arkin (1901) brought a drug rashes and other symptoms often mimic the clinical manifestations of infectious diseases in the concept of L. b., contrasting her drug poisoning. Name L. b., i.e., drug Allergy, cannot be extended to other important side side effects of medication - specific toxicities, dysbacteriosis, etc., for example, leukopenia, or aplastic anemia can have not only immunocytokine, but cytotoxic or antimetabolites mechanism (as at chloramphenicol).
Shock, characteristic for immediate response, usually in a few minutes after drug administration, most of parenteral and especially intravenous; is the tightness in the chest, dyspnea, cyanosis (sometimes after the initial severe redness of the face - "nitratoides crisis"), tachycardia with arrhythmia, collapse, convulsions, paralysis, sometimes with the development of angioedema, coming fast, often in the first 5-15 minutes, death (anaphylactic death). Section find bronhospazm, swelling of the lungs, overrun by the blood vessels of the abdominal cavity. In simpler cases, immediate response, especially when injecting drugs, is expressed only by itching, hives, sneezing, chills, fever.
Delayed reaction (erythema ninth day") usually after 5 - 9 days after the start of treatment and lasts about 1-2 weeks, in cyclically flowing common reaction in the form of generalized dermatitis type urticaria and other, itching, fever, joint injury, adenopathy, vasculitis, serositis, losing blood, nervous and other systems.
May occur local response of the contact type nettle blister or erythema on the subcutaneous or intramuscular injection drugs, swelling of the tongue, or throat with the introduction of drugs by inhalation, etc. or reaction resorptive character in the form of amplification of the inflammatory process in the lungs with hemoptysis, necrosis of tissue, such as pneumonia. L. B. individual patients may show isolated, as though independent, the defeat of one or another organ - the skin with bark, scarlatina-, sportovni the exanthema, purpura, erythema nodosum, exfoliative dermatitis; lungs with eosinophilic volatile infiltration, asthma, cardiovascular-interstitial pneumonia; the defeat of blood with agranulocytosis, aplastic or hemolytic anemia; heart with plasmocytoma-eosinophilic myocarditis, and so on; liver with eosinophilic, cholestatic, or severe hepatocellular hepatitis; kidneys with jade or nephrotic syndrome; nervous system with polinevrita, encephalitis and other, and also as lymphadenopathy and gepatolentikuliarnaya type reticulata, systemic vasculitis type of hemorrhagic or of periarteritis nodosa with the involvement of many agencies and so on
Medicinal disease usually occurs cyclically, quickly ending with recovery after the drug; however, it bears repeating, as a rule, when a new application of the same medication, often stereotyped form (fixed erythema, drug agranulocytosis, etc.), L. b. can't take and chronic course, not only due to repeated exposure to the specific allergen, but also agents of another nature (the phenomenon of paralleli), which is especially clearly observed during drug asthma and drug dermatitis. Section diagnosis L. B. delayed-type is confirmed by the defeat of the relevant body in the form of allergic myocarditis, vasculitis lungs with pneumonitis, hemorrhagic encephalitis, ulcero-necrotic gastritis, colitis, acute nephritis, aplastic bone marrow etc.
The diagnosis. L. B. recognized still not widely, often in the presence of skin rashes, urticaria, itching, fever, eosinophilia, leukopenia, resulting in apparent connection with the admission of the most highly sensitizing funds. Drug Allergy may, however, be manifested and isolated tachycardia, isolated arterial hypotension, accelerated ROHE, globulin shifts and other various signs after the introduction of even the most conventional medicines. By L. B. should include runny nose from iodine, also known with individual intolerance of quinine, sulfonamides, butadiona, etc.; infiltrates from the injection of camphor oil, accompanied by a high-eosinophilia of blood; cases of sudden death after intravenous administration of conventional doses of sulfobromophthalein, detract etc. Allergic, including fatal, reactions can occur on low-emission means, as penicillin, amidopirina (pyramidonum), Tofan, for years used in medicine without much side effects.
Drug allergies are predisposing diseases, which are accompanied by significant immunological reconstruction (infection, collagen, etc.,) and require systematic, often long-term use of active drugs. At the same time of the development of drug Allergy in such cases detected harder. For example, in patients with tuberculosis treated PASK, or in patients with congestive heart failure receiving Mercosul, a hemorrhagic vasculitis, leukopenia, eosinophilia may be a manifestation of how the underlying disease and drug intolerance. Currently, however, such complications are more often due drug Allergy.
Diagnosis of drug disease often reinforces the termination of fever and other symptoms with the abolition of the suspect in poor tolerance of drugs. Skin Allergy testing is practically reliable and not indifferent to the patient. Detection of specific antibodies and other similar complex diagnostic methods are available only in research laboratories. In some cases, L. b. may remain unrecognized, neither in life nor on the partition.
Treatment and prevention. At the first signs of drug anaphylactic shock immediately adrenaline injected subcutaneously or intramuscularly, and even (slowly) intravenous 0.3-0.5 ml of 0.1 % solution, if necessary, again, aminophylline (aminophylline) 0,24-0,48 g intravenous hydrocortisone 50 mg in 1 liter of physiological solution intravenously; also used oxygen therapy, artificial respiration, the usual exciting and antisense funds - diphenhydramine 5 ml of 1 % solution intramuscularly, novocaine. In each case of the use of drugs, especially of parenteral, suspected individual intolerance recommended to have at the ready syringe with epinephrine; in addition, parenteral enter the medication should in the distal part of a limb, so if you need to be able to delay the implementation of the drugs in the General blood shifting limbs patient with a tourniquet above the site of injection.
In severe L. b., flowing through weak type most appropriate to apply prednisone or other corticosteroids in high enough doses for a long time; medication that caused L. b., it is necessary to stop.
Use lighter antisense funds: a Dimedrol, promethazine (pipolfen), etsin, novocaine, acetylsalicylic acid (aspirin), calcium chloride, amidopyrine (pyramidonum), analginum (if not leukopenia), not forgetting that each of them may, in turn, can cause allergies. Seek to destroy, neutralize, or rather excrete become pathogenic medicine.
To prevent L. B. it is extremely important not to abuse drugs, especially in persons with allergic diatesom; thoroughly investigate each patient at least small signs of rejecting one or the other drug.
People suspected of sensitization to the drug, but with the proper indications for the treatment with this tool, give first minimum dose (for example, 1/100 treatment), avoiding possible parenteral, especially intravenous injection; the treatment is carried out under the protection of corticosteroids. Specific desensitization can be very rare.