Review of clinical cases of drug allergic reactions in patients with acute respiratory viral infections

Abstract

Introduction. Problem of drug-induced allergic reaction is especially actual both in well-developing countries as well as in countries of Eastern European region. By the WHO data, distribution of allergy is up to 30 %, and main reasons for that are increasing of pharmaceuticals consumption by a person, change of nutrition style towards more chemicals synthetic substitutions. Generally, a quantity of Europeans with allergy reach 150 mln. Reactions of hypersensitivity to medications is so serious discussion question among physicians and their patients, since it is the most important reason to stop treatment and for refuse remedies. Authors hope, that presenting here clinical material will bring benefit both clinicians and patients like cases of drug-induced allergic reactions due to self-prescribed treatment (antipyretics, antibiotics). Thus, this research paper aimed to analyze the clinical cases of drug-induced allergy in patients with acute respiratory illnesses, which had admitted to Infectious diseases department of Municipal Clinical Hospital of Chernivtsi city (Ukraine).

Materials & Methods. Descriptional clinical study enrolled six clinical cases of drug-induced allergy in male patients admitted in different time to the Infectious Diseases Department of Municipal Clinical Hospital of Chernivtsi city (Ukraine) with clinical manifestation and epidemiological data of acute respiratory viral infections. Mostly cases of drug-induced allergy confirmed by the indirect immune-termomistry for determination of role of a drug.

Results & discussion. First case in male 52 years old patient with signs of polymorphic exudative erythema induced by pills against common cold named «Coldflu». Patient had manifestation clinical features of acute respiratory viral infection and was hospitalized to the Department of Droplet infections for detoxicative and desensitization treatment. Within few days his infectious problem had solved, nevertheless skin rash still need care, and he had referred to Dermatologic dispensary to continue his treatment. Another 48 years old patient presented on a second day of common cold the big spotted rash after once taking of the same drug «Coldflu». He continued to use the drug even oftener and the rash distributed more over all skin covers, and big spots became dark reddish and with cyanotic tone. Immediately he transferred to the Hospital with chief complaints on dyspnea, high-grade fever 39⁰C, and general weakness. Objectively: severe state, he has a few ulcers 0.2-0.3 mm on mucous membranes of oral cavity. His skin over trunk fully covered with generalized rash elements elevated over surface. His treatment included prednisolon 60 mg i/v, enterosorbent, detoxication therapy i/v, gluconate calcium, hepatoprotector per os. Third case induced by aspirin use and characterized by small spotty rash on back and extremities. Three more cases induced by antibiotics consumption: one is in 28 years old male after prescription of amoxiclav by general practitioner – macula-papula rash appeared on hands; two more case induced by ampicillin pills used per os. Generally, the drug-induced allergy the most frequently happens on antibiotics. The finally, biotransformation of drugs and immune pathogenesis is not clear up, but assumed the mentioned above, we may imagine next scenario: for stimulating null T-lymphocytes, dendric cells firstly processing antigen. Later it transported to regional lymph nodes, where antigen must presenting to null T-cells. Antigen-specific T-cells migrates to target organs, and after repeated influence of antigen, they activated and start secreted cytokines that regulated reactions and cytotoxins (granulosin, perforins) which proper lead to tissue damage.

Conclusions. Thus, problem of allergy is global, self-prescribed treatment and uncontrolled use of medications generally assist for occurrence of drug-induced allergy clinical cases (here «Сoldflu», «Aspirin», «Amoxiclav», «Ampicillin»).Important is repeated «meeting» with provoking antigens, as well as role of certain immune dysfunction in patients with acute respiratory viral infection (especially caused by influenza viruses) must be present too. Skin allergy manifestation in described clinical cases include generalized exudative polymorphic erythema, allergic dermatitis of extremities, systemic disorders (dyspnea, hyperthermia, arterial hypotension).