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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Clinical and laboratorial investigation in patients with suspected drug allergy in a tertiary hospital / InvestigaÃÃo clÃnico laboratorial de pacientes com suspeita de reaÃÃes de hipersensibilidade alÃrgica a fÃrmacos em hospital terciÃrio

Luciana Mabel Ferreira Vasconcelos 19 January 2012 (has links)
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Allergic drug reactions account for 6.5% of hospital admissions, prolonged hospitalization 15.1% of patients and are severe in 6.7% of patients. There are difficulties in understanding the immune mechanisms, diagnosis and treatment of patients. Therefore, such reactions are considered a Public Health problem. The objective of this study was to describe the cases of patients with suspected allergic hypersensitivity to drugs and to evaluate the response of individuals to skin tests. A total of 63 patients were included in the study. The experimental design was a cross-sectional observational study from June 2008 to October 2011. We applied a questionnaire to investigate the clinical and laboratory informations. Eight patients received other diagnosis and three died due to other reasons, so that 52 patients completed the study. Most patients were men (56.36%), non atopic, with a median age of 52 year. The drugs most commonly implicated were NSAIDs and the oral administration was the most commonly route used. It was documented 69 suspected reactions; most of them were considered as delayed hipersensitivity. Maculopapular rash and erythema multiforme were the most frequent manifestations. According to the severity of the reactions, most was considered moderate (72.46%). The patch test was performed in 22 patients for investigation of delayed reaction. Seven cases were positive (31.81%), DRESS (rash with eosinophilia and systemic symptoms) caused by captopril (+), contact eczema by rifamycin (+ +), lichenoid eruption by captopril (+), maculopapular rash + ampicillin and cephalexin to angioedema (+), two cases of fotoeczema one by captopril and another by AAS, both with positive results (+) and one case of Stevens-Johnson syndrome caused by phenytoin (++). For immediate hypersensitivity, 3 in 10 patients have shown positive results for prick test with AAS diluted to 1/1000. It was possible to confirm the liability of the drug reactions in 19 (27.53%), which demonstrated the importance of application of skin tests in the clinical investigation of allergic drug reactions. As for causality, 26 reactions were considered possible, 20 defined, 13 probable, 9 and a conditional reaction was considered not related to drugs. Given its importance, the performance of skin tests with these patients has opened perspectives on the possibility to incorporate this service in routine outpatient Dermatology HUWC. / As reaÃÃes alÃrgicas medicamentosas sÃo responsÃveis por 6,5% das admissÃes hospitalares, prolongam a hospitalizaÃÃo de 15,1% dos pacientes e sÃo graves em 6,7% dos pacientes. Hà dificuldades quanto à compreensÃo dos mecanismos imunolÃgicos, diagnÃstico e tratamento dos pacientes. Portanto, tais reaÃÃes sÃo consideradas um problema de saÃde pÃblica. O objetivo deste trabalho foi descrever os casos de pacientes com suspeita de hipersensibilidade alÃrgica a fÃrmacos e avaliar a resposta desses indivÃduos aos testes cutÃneos. Um total de 63 pacientes foram incluÃdos no trabalho, cujo delineamento experimental foi de um estudo observacional descritivo transversal realizado entre junho de 2008 e outubro de 2011. Utilizou-se um questionÃrio para investigaÃÃo das informaÃÃes clÃnico-laboratoriais. Oito pacientes receberam outro diagnÃstico e trÃs foram a Ãbito por outros motivos, de forma que 52 pacientes completaram o estudo. A maioria dos pacientes era homem (56,36%), nÃo atÃpicos, com mediana de idade de 52 anos. Os fÃrmacos mais implicados foram os AINES (anti-inflamatÃrios nÃo esteroidais) e a via oral foi a mais utilizada. Foram documentadas 69 reaÃÃes suspeitas, a maioria do tipo tardia. Exantema maculopapuloso e eritema multiforme foram as manifestaÃÃes mais freqÃentes entre as reaÃÃes tardias. Quanto à gravidade, a maioria foi considerada moderada (72,46%). O teste de contato foi realizado em 22 pacientes para investigaÃÃo de reaÃÃo tardia. Em sete casos, houve resultado positivo (31,81%), ou seja, DRESS (Rash com eosinofilia e sintomas sistÃmicos) causado por captopril (+), eczema de contato por rifamicina (++), erupÃÃo liquenÃide por captopril (+), exantema maculopapuloso + angiodema para cefalexina e ampicilina (+), dois casos de fotoeczema, um por captopril e outro por Ãcido acetilsalicÃlico (AAS), ambos com resultado (+) e um caso de sÃndrome de Steven-Johnson por fenitoÃna (++). Foram realizados dez testes de puntura e em trÃs pacientes houve positividade para AAS diluÃdo a 1/1000. Foi possÃvel confirmar a imputabilidade do fÃrmaco em 19 reaÃÃes (27,53%), o que demonstra a importÃncia da aplicaÃÃo dos testes cutÃneos na investigaÃÃo clÃnica das reaÃÃes alÃrgicas a medicamentos. Quando à causalidade, 26 reaÃÃes foram consideradas possÃveis, 20 definidas, 13 provÃveis, 9 condicionais e uma reaÃÃo foi considerada nÃo relacionada com fÃrmacos. Dada a sua importÃncia, a realizaÃÃo dos testes cutÃneos com esses pacientes abriu perspectivas sobre a possibilidade incorporar esse serviÃo na rotina do ambulatÃrio de Dermatologia do HUWC.

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