Çocuklarda non-steroidal anti inflamatuvar ilaç hipersensitivitesini ön gören faktörler
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2017
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İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Non-steroidal anti inflamatuvar ilaç (NSAİİ)' lar, ilaçlara bağlı hipersensitivite reaksiyonlarının en sık nedenlerinden biridir. NSAİİ hipersensitivite tanısını öyküye dayanarak koymak çoğunlukla yanıltıcı olmaktadır. Bu nedenle gerekli durumlarda deri testleri ve/veya oral provokasyon testleri yapılmalıdır. Nisan 2013 ile Mart 2015 tarihleri arasında erken tip NSAİİ hipersensitivitesi öyküsü ile İnönü Üniversitesi Çocuk İmmünolojisi ve Alerjisi polikliniğine başvuran hastalar çalışmaya alınmıştır. Çalışmaya, toplam 50 hasta alınmıştır. Çalışmaya alınan hastaların 22 (%44)' si kız ve 28 (%56)' i erkek idi. Hastaların ortanca yaşı 6 (1-16) idi. Daha öncesinde NSAİİ ile erken tip hipersensitivite reaksiyonu tarifleyen 13 hasta (%26) vardı. Sekiz (%16) hasta birden fazla NSAİİ grubuna karşı erken tipte reaksiyon tarifliyordu. Hastaların 7 (%14)' sine astım, 7 (%14)' sine alerjik rinit ve 8 (%16)' ine besin alerjisi eşlik ediyordu. NSAİİ'lara karşı gelişen erken tip reaksiyonların %50'si ilk 1 saat içerisinde gelişmişti. NSAİİ hipersensitivite öyküsü ile başvuran hastaların 28'ine deri prik /intradermal testler yapıldı. Toplam 13 (%26) hastada (2'si intradermal test sonucuna göre, 11'i oral provokasyon test sonucuna göre), NSAİİ hipersensitivitesinin olduğu ispatlanmış oldu. NSAİİ'lara karşı erken tip hipersensitivitesi olduğu ispatlanan hasta grubu ile hipersensitivitesi olmadığı ispatlanan hasta grubu tek yönlü analiz ile karşılaştırıldıklarında; oral provokasyon testi pozitif olan grupta, hastaların 6 yaşından büyük olması (p=0,006), ailelerinde NSAİİ hipersensitivite öyküsünün olması (p=0,039), birden fazla NSAİİ grubuna karşı erken tipte hipersensitivite öyküsünün olması (p=0,01) ve reaksiyonun ilaç alımından sonraki ilk 1 saat içerisinde ortaya çıkması daha fazla idi (p=0,004). Öyküden NSAİİ hipersensitivitesini ön gören bağımsız faktörleri belirlemek için lojistik regresyon analizi yapıldığında ise reaksiyonun ilaç alımından sonra ilk 1 saat içerisinde ortaya çıkması (OR: 22,81, 95%CI: 1,520-342,457, p=0,024) ve birden fazla NSAİİ grubuna karşı erken tipte hipersensitivitenin olması (OR: 22,85, 95%CI: 1,337- 390,554, p=0,031) gerçek NSAİİ hipersensitivitesini ön gören faktörler idi. iv Erken tip NSAİİ hipersensitivite öyküsü veren hastalarda; öyküye dayanarak tanı asla konulmamalı, gerekli hastalarda deri testleri ve oral provokasyon testleri yapılmalıdır. Tanıyı kesinleştirmek için deri testleri ve/veya oral provokasyon testleri mutlaka yapılmalıdır. Öyküde ilaç alımından sonra ilk 1 saat içerisinde reaksiyon gelişmesi ve birden fazla NSAİİ grubuna hipersensitivite öyküsünün olması, gerçek NSAİİ hipersensitivitesini ön gören faktörlerdir.
NSAIDs are one of the most common cause of drug related hypersensitivity reactions. The diagnosis of hypersensitivity to NSAID that based on clinical history is generally misleading. Therefore, in necessary situations skin tests and/or oral provocation tests (OPT) should be performed. The study population was chosen from patients who applied to Department of Allergy and Immunology, Inonu University Hospital in the April 2013 to March 2015 with history of Type 1 (immediate) hypersensitivity to NSAID (NSAID-H). In total 50 patients were included. Of these 50 patients, 22 (44%) were males, 28 (56%) were females, a mean age of 6 (range 1 to 16). 13 (26%) patients described having type 1 NSAID-H reactions in the past. 8 (16%) patients described having these reactions to more than one type of type 1 NSAIDs. 7 (14%) patients had asthma, 7 (14%) patients had allergic rhinitis and 8 (16%) patients had food allergy. 50 % of type 1 NSAID-H reactions had occured in the first hour of medication. 28 of the patients underwent skin prick/intradermal tests. NSAID-H was proven in 13 of 50 (2 of them according to intradermal tests, 11 of them according to OPT). Patients were stratified into 2 groups: those with confirmed NSAID-H and those without NSAID-H. When a one way analysis is used to compare between these two groups the OPT positivie group had more risk factors such as being older than 6 years of age (p=0,006), a positive family history (p=0,039), having a clinical history of hypersensitivity to more than one type of type 1 NSAID (p=0,001), the onset of allergic reaction in the first hour of medication (p=0,004). When logistic regression analysis is used to determine unrelated predictive factors of NSAID-H from clinical history, the onset of allergic reactionin the first hour of medication (OR:22,81 %95 CL 1,520-342,457, P=0,024) and the type 1 hypersenstivity to multiple NSAID drugs (OR:22,85 %95 CL 1,337-390,554 p=0,031) were predictive factors of true NSAID-H. The definitive diagnosis should not be made based on clinical history, when required skin tests and OPTs must be performed. Skin tests and/or OPT must be done to vi establish a firm diagnosis. The history of hypersensitivity to multiple NSAID drugs and the onset of allergic reaction in the first hour of medication are predictive factors of true NSAID-H.
NSAIDs are one of the most common cause of drug related hypersensitivity reactions. The diagnosis of hypersensitivity to NSAID that based on clinical history is generally misleading. Therefore, in necessary situations skin tests and/or oral provocation tests (OPT) should be performed. The study population was chosen from patients who applied to Department of Allergy and Immunology, Inonu University Hospital in the April 2013 to March 2015 with history of Type 1 (immediate) hypersensitivity to NSAID (NSAID-H). In total 50 patients were included. Of these 50 patients, 22 (44%) were males, 28 (56%) were females, a mean age of 6 (range 1 to 16). 13 (26%) patients described having type 1 NSAID-H reactions in the past. 8 (16%) patients described having these reactions to more than one type of type 1 NSAIDs. 7 (14%) patients had asthma, 7 (14%) patients had allergic rhinitis and 8 (16%) patients had food allergy. 50 % of type 1 NSAID-H reactions had occured in the first hour of medication. 28 of the patients underwent skin prick/intradermal tests. NSAID-H was proven in 13 of 50 (2 of them according to intradermal tests, 11 of them according to OPT). Patients were stratified into 2 groups: those with confirmed NSAID-H and those without NSAID-H. When a one way analysis is used to compare between these two groups the OPT positivie group had more risk factors such as being older than 6 years of age (p=0,006), a positive family history (p=0,039), having a clinical history of hypersensitivity to more than one type of type 1 NSAID (p=0,001), the onset of allergic reaction in the first hour of medication (p=0,004). When logistic regression analysis is used to determine unrelated predictive factors of NSAID-H from clinical history, the onset of allergic reactionin the first hour of medication (OR:22,81 %95 CL 1,520-342,457, P=0,024) and the type 1 hypersenstivity to multiple NSAID drugs (OR:22,85 %95 CL 1,337-390,554 p=0,031) were predictive factors of true NSAID-H. The definitive diagnosis should not be made based on clinical history, when required skin tests and OPTs must be performed. Skin tests and/or OPT must be done to vi establish a firm diagnosis. The history of hypersensitivity to multiple NSAID drugs and the onset of allergic reaction in the first hour of medication are predictive factors of true NSAID-H.
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ŞAYAN, YEKBUN G.(2017). Çocuklarda non-steroidal anti inflamatuvar ilaç hipersensitivitesini ön gören faktörler,The factors that predict the non- steroidal anti inflammatory DRUG hypersensitivity in children.
