İlaç allerjilerinde deri prik testi ve intradermal testlerin tanısal değerinin araştırılması
Küçük Resim Yok
Tarih
2009
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İlaç allerjilerinin tanısında deri prik ve intradermal testlerinin tanısal değerini araştırdığımız çalışmamıza öyküsünde beta-laktam grubu antibiyotiklerle reaksiyon tanımlayan 29 çocuk alındı. Avrupa İlaç Allerjisi Ağı tarafından geliştirilen standardize anamnez formlarına göre olguların klinik öykü bilgileri değerlendirmeye alındı. Olgulara ilk olarak ilaç allerjileri tanısında kullanılan standardize protokollere göre prik ve intradermal testler, deri testleri negatif bulunan olgularda ilaç provokasyon testleri uygulandı.Deri semptomları en sık bildirilen reaksiyondu (%96.6). Reaksiyonlara en sık neden olan ilaç amoksisilin/klavulanik asit (%38) olarak belirlendi. Reaksiyonlara neden olan ilaçların en sık (%61.3) oral yolla uygulandığı saptandı. Çalışmaya alınan tüm olgularda öyküde reaksiyon tanımlanan beta-laktam grubu antibiyotiklerin uygun dilüsyonları ile yapılan deri prik ve intradermal testleri negatif sonuç verdi. Olguların %27.6'sında ilaç provokasyon testleri pozitif olarak değerlendirildi. Öyküde reaksiyon tanımlanan antibiyotik dışında penisilin ve ampisiline çapraz reaksiyon oranı %17.2 olarak saptandı. Deri prik ve intradermal testleri için duyarlılık %0, özgüllük %100, doğruluk %80, pozitif kestirim değeri %0 ve negatif kestirim değeri %80 olarak belirlendi.İlaç allerjilerinin tanısı öykü, klinik bulgular, fizik muayene, deri testleri ve diğer laboratuvar testleri ile konulmaktadır. Genellikle birçok ilaç birlikte kullanıldığından ve gelişen semptomların nedeni kullanılmakta olan ilaçların herhangi biri olabileceğinden, öykü sıklıkla güvenilir bir tanı yöntemi değildir. Birçok doktor yalnızca öykü ve ilaç allerjisi tanısında kullanılan bazı kaynak kılavuzlara dayanarak tanı koymaktadır. Bu tarz bir yaklaşım ilaç allerjilerinin epidemiyolojisinde yanlış yorumlara neden olmaktadır. Deri testleri IgE aracılıklı reaksiyonların tanısında en sık kullanılan yöntemdir ve ilaç allerjilerinin tanısında birincil test olarak kabul edilirler. Pozitif ilaç allerjisi öyküsü ve negatif deri testi bulunan hastalarda ilaç allerjisinin tanısında ?altın standart? olarak kabul edilen ilaç provokasyon testleri uygulanmalıdır.
In our study we evaluated diagnostic value of skin prick test and intradermal tests in drug allergy diagnosis and 29 children who described reaction to beta-lactam antibiotics were admitted. History informations of subjects were assessed according to standardized European Network for Drug Allergy questionnaires. Prick and intradermal tests were performed beforehand in accordance with standardized protocols used for drug allergy diagnosis. Afterwards, the subjects with negative skin tests underwent provocation tests.Skin reactions were most commonly reported symptoms (96.6%). The most common reaction causing drug was amoxicillin/clavulanic acid (38%) and it was determined that drugs which were the cause of reaction were used most commonly by oral route (61.3%). Skin prick and intradermal tests performed with appropriate dilusions of beta-lactams which were described in history as causing reaction resulted negative for all subjects admitted to the study. Drug provocation tests were positive in 27.6% of the subjects. Except the reaction described antibiotic in history, cross reaction rate between penicillin and ampicillin was estimated as 17.2%. The sensitivity for prick and intradermal tests was 0%, specifity was 100%, validity was 80%, positive predictive value was 0% and negative predictive value was 80%.Drug allergies can be diagnosed by history, clinical evidences, skin tests and other laboratory tests. History is mostly not a reliable diagnostic method because of multiple drug intake and occuring symptoms can be result of any drug that is used. Many physician diagnose drug allergy by only history and according to some guidelines used for drug allergy diagnosis. This kind of approach causes erroneous explanations for drug allergy epidemiology. Skin tests are most frequently used method in diagnosis of IgE mediated reactions and they are considered as primary tests in diagnosis of drug allergy. Drug provocation tests assumed as ?gold standart? in drug allergy diagnosis must be applied to patients with positive drug allergy history and negative skin test.
In our study we evaluated diagnostic value of skin prick test and intradermal tests in drug allergy diagnosis and 29 children who described reaction to beta-lactam antibiotics were admitted. History informations of subjects were assessed according to standardized European Network for Drug Allergy questionnaires. Prick and intradermal tests were performed beforehand in accordance with standardized protocols used for drug allergy diagnosis. Afterwards, the subjects with negative skin tests underwent provocation tests.Skin reactions were most commonly reported symptoms (96.6%). The most common reaction causing drug was amoxicillin/clavulanic acid (38%) and it was determined that drugs which were the cause of reaction were used most commonly by oral route (61.3%). Skin prick and intradermal tests performed with appropriate dilusions of beta-lactams which were described in history as causing reaction resulted negative for all subjects admitted to the study. Drug provocation tests were positive in 27.6% of the subjects. Except the reaction described antibiotic in history, cross reaction rate between penicillin and ampicillin was estimated as 17.2%. The sensitivity for prick and intradermal tests was 0%, specifity was 100%, validity was 80%, positive predictive value was 0% and negative predictive value was 80%.Drug allergies can be diagnosed by history, clinical evidences, skin tests and other laboratory tests. History is mostly not a reliable diagnostic method because of multiple drug intake and occuring symptoms can be result of any drug that is used. Many physician diagnose drug allergy by only history and according to some guidelines used for drug allergy diagnosis. This kind of approach causes erroneous explanations for drug allergy epidemiology. Skin tests are most frequently used method in diagnosis of IgE mediated reactions and they are considered as primary tests in diagnosis of drug allergy. Drug provocation tests assumed as ?gold standart? in drug allergy diagnosis must be applied to patients with positive drug allergy history and negative skin test.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Allerji ve İmmünoloji, Allergy and Immunology ; Çocuk Sağlığı ve Hastalıkları
