氨基糖苷类药物致过敏性休克报告相关因素分析

目的:通过对氨基糖苷类药物致过敏性休克报告相关因素的分析,了解氨基糖苷类药物致过敏性休克的一般规律和特点。方法:检索1996—2011年国内文献报道的有关氨基糖苷类药物致过敏性休克的报道137例,进行分类、统计、分析。结果:氨基糖苷类致过敏性休克涉及9种药物,其中庆大霉素最多,占32.85%,其次为阿米卡星,占27.00%;给药途径以静脉滴注为主,占54.74%;5 min内发生过敏性休克最多,64例,占46.72%;致死病例12例,占总例数的8.76%。结论:临床应重视氨基糖苷类药物致过敏性休克的重要不良反应及用药监测,以确保用药的安全。     

喹诺酮类药物致过敏性休克63例文献分析

目的:了解喹诺酮类药物致过敏性休克的情况,为临床用药的安全性提供参考.方法:通过检索1994年～2003年国内公开发表的51种医药期刊中有关喹诺酮类药物致过敏性休克报道58篇,并对病例进行统计分析.结果:10年中喹诺酮类药物致过敏性休克病例63例,其中导致死亡1例.结论:喹诺酮类药物无论注射或口服,均可导致过敏性休克,若抢救不及时将危及患者生命,提醒医护人员、患者及家属在使用此类药物时一定要引起高度重视.     

3种中药注射剂致过敏性休克文献分析

目的：探讨双黄连、清开灵、穿琥宁3种具有抗病毒作用的中药注射剂致过敏性休克的一般规律及特点。方法：对近10年国内文献报道的有关3种中药注射剂致过敏性休克163例进行统计、分析。结果：3种中药注射剂致过敏性休克与性别、年龄无关，与药物成分及制剂杂质、联合用药等因素有关；过敏性休克主要发生于用药30min之内，占总例数的82．74％；死亡9例，占总例数的5．52％。结论：临床应重视3种常用中药注射剂的严重不良反应，以确保用药安全。     

青霉素类药物不良反应分析

目的分析青霉素类引起药物不良反应（ADR）病例,探讨青霉素类药物ADR的种类和一般特点,促进临床合理使用该类药物。方法对搜集到的青霉素类药物不良反应报告进行整理、分类,并进行统计分析。结果筛选出2004年~2008年报道的96例ADR中,儿童患者最多,占总例数的55.21%（53例）;以静脉滴注方式给药引发的ADR最多,占总例数的95.83%（92例）;临床表现以药物疹的最多,占总例数的26.04%（25例）;死亡病例为8例,占总例数的8.33%。结论临床应重视青霉素类药物的不良反应,避免或减少不良反应,确保用药安全。     

308例氟喹诺酮类药致不良反应分析

目的:了解氟喹诺酮类药致不良反应(ADR)发生的特点及规律。方法:通过检索1994年1月～2009年6月中国医院数字图书馆(CHKD)期刊全文数据库收载的中文医药卫生期刊,共收集到有效的有关氟喹诺酮类药致不良反应文献231篇,共308例,并进行统计、分析。结果:308例氟喹诺酮类药致ADR与患者性别、年龄无显著相关性;致ADR的给药途径以静脉滴注为主,占76.62%;用药后2～5d内出现ADR的比例较大,占33.44%;左氧氟沙星致ADR的例数最多,占19.81%;ADR累及器官或系统以中枢神经系统损害较常见,占30.43%,其次是皮肤及其附件损害,占20.58%,严重者可出现过敏性休克死亡(6例)。结论:临床应高度重视氟喹诺酮类药致ADR的监测,合理选用,确保用药的安全、有效。     

92例氟喹诺酮类药物不良反应临床分析报告

目的 总结氟喹诺酮类药物在临床应用中的不良反应发生规律及特点,为临床合理用药提供依据.方法 回顾性分析我院2008～2011年间收治的92例使用氟喹诺酮类药物后出现不良反应患者的临床资料.结果 氟喹诺酮类药物不良反应发生率男性高于女性,60岁以上患者的药物不良反应发生例数最多,占58.7%,且随着年龄的增大药物不良反应发生的几率也随之增大.诺氟沙星和左氧氟沙星引起的不良反应共占81.6%,不良反应临床表现主要以消化道反应为主,静脉给药致不良反应发生率高于口服给药.结论 临床使用氟喹诺酮类药物要严格掌握用药指征,严格掌握适应证,科学选择用药剂量和给药途径,保证用药安全,以降低不良反应的发生率.     

抗感染药物171例不良反应回顾性分析

目的：统计上海交通大学医学院附属仁济医院抗感染药药品不良反应（ADR）的发生情况及引发ADR的相关因素.方法：对本院2004年5月-2006年6月收集到的171例ADR进行汇总分析.结果：171例ADR中,静脉给药引发的ADR有140例,占总例数的81.87%.头孢菌素类抗生索引起的ADR居首位,其次为喹诺酮类抗菌药.皮肤及附件损伤是ADR的最主要表现,占总例数的61.40%,较严重的ADR有18例,占总例数的10.53%,最严重的为过敏性休克（6例）.结论：上报的抗感染药物发生ADR的例数与药品种类、给药途径等多种因素相关,应审慎用药,以减少或避免ADR的发生.     

191例氟喹诺酮类药物不良反应分析

目的:调查我院氟喹诺酮类抗菌药物不良反应发生的情况和特点.方法:收集我院上报的191例氟喹诺酮类药物的不良反应报告,按患者的一般情况、涉及药物、给药方式、不良反应涉及器官及临床表现等方面进行汇总和分析.结果:不良反应主要发生在60岁以上患者中(45.02% );女性不良反应的发生比例明显高于男性;共涉及3种氟喹诺酮类药物,主要以左氧氟沙星为主;严重不良反应事件为3例(1.57%),皆为过敏性休克;引起不良反应的主要给药途径为静脉给药(164例,85.90% ) ;不良反应主要损害类型为皮肤及其附件损害、消化系统损害.结论:加强氟喹诺酮类药物不良反应的监测工作,以减少氟喹诺酮类药物不良反应、提高临床合理用药水平.     

喹诺酮类药物致肝毒性文献分析

目的:了解喹诺酮类药物致肝毒性发生的特点和规律,为临床安全用药提供参考。方法:以"喹诺酮""沙星""肝毒性""肝损害""Hepatotoxicity"等为检索词,系统检索中国知网、万方、维普、PubMed等国内外数据库(检索时间均为各数据库建库起至2017年12月31日)收录的喹诺酮类药物致肝毒性个案报道的相关文献,并进行汇总与分析。结果:共收集有效文献59篇,获取喹诺酮类药物致肝毒性病例61例,涉及环丙沙星、莫西沙星、氧氟沙星、洛美沙星、诺氟沙星、左氧氟沙星、加替沙星、依诺沙星等8个品种。其中,环丙沙星、左氧氟沙星、莫西沙星、氧氟沙星致肝毒性较多,分别为19、13、11、7例次,累积构成比达81.97%。男、女性患者比例为1.54∶1,以61～80岁患者居多(共30例,占49.18%)。原患疾病为单一病种的有46例(占75.41%),以呼吸系统、泌尿生殖系统感染为主;合并其他疾病的有15例(占24.59%)。单独应用喹诺酮类药物的有31例,以环丙沙星的最多;联合用药的有30例。静脉给药的有34例,以国内病例为主。肝毒性最早出现在用药后10 min内,最晚出现用药8周后;有49例患者在用药后10 d内出现肝毒性,占80.33%。临床症状除全身乏力、恶心呕吐等外,还包括丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素等指标的异常升高。54例患者经停药或对症处理后好转,7例患者死亡。药物性肝损伤因果关系评价结果显示,极可能有关的有4例,很可能有关的有45例,可能有关的有12例。结论:喹诺酮类药物致肝毒性与药物品种、患者年龄、原患疾病、联合用药、给药途径等有关,且多发生在用药后10 d内。临床应密切关注患者的肝功能指标,加强用药监护,谨慎联合用药。     

减肥药物致462例不良反应文献分析

目的:了解减肥药物的不良反应,为临床合理用药提供参考。方法:对1980年~2004年国内、外公开发行的62种医药期刊报道的减肥药物致药品不良反应(ADR)462例进行分类统计、分析。结果:由拟5-羟色胺食欲抑制药引发的ADR较多,占总例数的36.36%;ADR涉及人体多个系统,尤以心血管系统所占比例最大,占总例数的53.68%;预后的死亡率,占总例数的18.61%。结论:减肥药物致ADR的发生与多种因素有关,医务工作者应加强减肥药物的用药指导及监测,以避免不良反应的发生。     

氟喹诺酮类药物引起血糖异常71例文献分析

目的：探讨氟喹诺酮类药物引起血糖异常的特点,为临床安全用药提供参考。方法：通过数据库搜索2000年1月-2010年1月氟喹诺酮类药物引起血糖异常的相关文献。结果：引起血糖异常涉及7种氟喹诺酮类药物,共71例;60岁以上老年人多见,有44例（61．97％）;低血糖多见,一般出现在首次用药后1～3d,高血糖通常发生在首次用药3d后;引起血糖异常的氟喹诺酮类药物以加替沙星居多,有46例（64．78％）。结论：氟喹诺酮类药物引起血糖异常与多种因素有关。医务人员应重视氟喹诺酮类药物引起血糖异常的现象,在用药时应加强对患者的血糖监测,确保用药安全。     

他汀类药物致过敏反应分析

目的:探讨他汀类药物致过敏反应发生的特点和规律,为临床合理用药提供参考。方法:选取2015年1月至2021年3月该院不良反应监测网上报的他汀类药物致过敏反应病例,同时检索2000年1月至2021年3月中国知网、万方数据库和维普数据库收录的他汀类药物致过敏反应文献,对病例进行统计分析。结果:该院上报他汀类药物致过敏反应4例,检索文献获得他汀类药物致过敏反应的个案报道26篇(26例),共30例;其中男性患者19例(占63.33%),女性患者11例(占36.67%);患者年龄为32～85岁,平均年龄为61.4岁;过敏反应发生时间最短为口服后5 min,最长为连续口服6个月,其中17例(占56.67%)发生于用药后≤3 d;过敏反应包括皮肤过敏(19例)、过敏性休克(3例)、血管神经性水肿(5例)、药物热(2例)和过敏性哮喘(1例);5例(占16.67%)报告了更换其他调节血脂药替代治疗方案。结论:他汀类药物可导致休克、血管神经性水肿和过敏性哮喘等过敏反应,用药时应注意患者的用药监护,特别是首次用药初期;出现不良反应,应及时上报;对于应用他汀类药物利大于弊的患者,应阐明发生过敏反应时的替代治疗...     

警惕喹诺酮类药物引起血糖异常的不良反应

目的了解国内喹诺酮类药物引起血糖异常的不良反应。方法采用回顾性调查方法,收集1960年～2006年4月国内公开报道喹诺酮类药物引起血糖异常的不良反应文献,并进行统计分析。结果引起血糖异常涉及7种喹诺酮类药物,共19例,致低血糖16例(其中因低血糖昏迷致死3例),致血糖升高3例。结论对于老年患者、肾功能不全的糖尿病患者使用喹诺酮类药物要特别慎重,必须使用该类药时应监测患者血糖变化情况,以确保用药安全。     

头孢菌素类药物皮肤过敏的试验及皮试方法的研究

目的观察和分析头孢菌素类药物皮肤过敏的实验以及皮试方法。方法选择我院2010年1月至2011年1月接收的治疗过程中使用头孢菌素类药物的500例住院患者,随机平均分成皮试组与非皮试组,分别观察患者用药后的情况。结果有青霉素过敏史的患者占19.80%,皮试阳性占有率中,其他物质过敏史的占12.02%,无过敏史的占0.55%;皮试阴性组用药后发生的不良用药反应以及过敏反应明显低于非皮试组患者,两组数据差异显著,具有统计学意义。结论影响头孢菌素类药物出现不良药物反应以及皮试阳性发生率的主要因素是患者的过敏史,因此,对具有过敏史患者用药前应该对患者进行采取拟用药皮试。     

Pharmacy-controlled documentation of drug allergies

The implementation of a pharmacy-enforced policy for documenting drug allergies is described. After two incidents at a 600-bed teaching hospital in which patients experienced severe allergic reactions to drugs, an audit was conducted to evaluate the existing drug allergy documentation policy. Physicians documented allergies in medical charts and treatment orders for 68% and 78% of patients, respectively; no initial drug orders contained this information. Nurses documented allergies in admission assessments, medication records, and charts for 71%, 61%, and 15% of patients, respectively. Only 2% of pharmacy computerized drug profiles contained allergy information. A new policy for drug allergy documentation was instituted. Physicians provide allergy information on the first written drug order. Nurses independently solicit allergy information and check it against that provided by the physician. Pharmacists enter the information into the patient's drug profile. If the information has not been obtained, the drug is not dispensed. Repeat audits two months and one year after the policy was put in place showed significant improvements in the completeness and accuracy of drug allergy documentation by pharmacists and physicians. In general, documentation by nurses did not improve to the degree found for pharmacists and physicians. A policy that gave pharmacists the primary responsibility for ensuring that drug allergy information was obtained before drugs were dispensed was effective in improving allergy documentation by physicians and pharmacists.     

Anaphylaxis to lidocaine with tolerance to articaine in a 12 year old girl

True allergic reactions to local anesthetics are extremely rare and constitute less than 1% of all reactions. In addition, many of those allergic reactions are caused by the preservative constituents of the local anesthetics. Here we report a 12 year old girl with anaphylaxis to lidocaine (an amide local anesthetic) on two occasions. The allergy was confirmed by positive skin prick test to the drug. Skin testing and challenge to another amide local anesthetic (articaine) were negative. Subsequently, its use was well tolerated in a dental procedure. Up to our knowledge, this is the first report of a patient who is allergic to lidocaine and tolerant to articaine.Abbreviations: LA, local anesthetic; SPT, skin prick test; SQ, subcutaneous     

The prevalence of suspected and challenge-verified penicillin allergy in a university hospital population

Suspected penicillin allergy is common among hospitalised patients, but the quality of the information given by the patient is often doubtful. Alleged penicillin allergic are likely to be treated with more toxic, broad-spectrum, and more expensive antibiotics, with effects on microbial resistance patterns and public economy as a consequence. We performed a cross-sectional case-control study with two visits to all clinical departments of a large university hospital in order to find in-patients with medical files labelled "penicillin allergy" or who reported penicillin allergy upon admission. Patient histories were obtained via a questionnaire, and they were offered investigation for penicillin allergy with specific IgE, basophil histamine release, skin prick tests, intradermal tests and drug challenge tests. Finally, the pharmaco-economical consequences of the penicillin allergy were estimated. In a cohort of 3642 patients, 96 fulfilled the inclusion criteria giving a point-prevalence of alleged penicillin allergy of 5% in a hospital in-patient population. Mean time elapsed since the alleged first reaction to penicillin was 20 years. The skin was the most frequently affected organ (82.2%), maculo-papular exanthema (35.4%) and urticaria (10.4%) being the most frequently reported reactions. 25% did not recall the time of their reaction. 82.2% did not remember the name of the penicillin they reacted to. 34.8% had been treated with penicillins after suspicion of penicillin allergy had been raised. None of these reacted to penicillins. 33.3% of the patients receiving antibiotics during their current hospitalisation were prescribed penicillins. 2% developed non-severe exanthema. The average acquisition costs for antibiotics to penicillin allergic patients were euro 278, compared to euro 119 had they been non-allergic. The prevalence of suspected penicillin allergy was lower than reported elsewhere. A substantial number of patients failed to recall basic information about their alleged allergy. Patients reporting penicillin allergy upon admission and labels stating penicillin allergy on medical files are ignored in almost a third of patients receiving antibiotics. The acquisition costs for antibiotics to penicillin allergic patients were higher, compared to the cost had the patients been non-allergic.     

66例清开灵注射液不良反应文献分析

目的:探讨清开灵注射液所致不良反应(ADR)的一般规律及特点,为临床合理用药提供参考。方法:检索2003~2006年多种中文期刊中公开报道的有关清开灵注射液ADR的个案病例报道,并进行统计分析。结果:清开灵注射液引起的ADR男性多于女性,儿童和青壮年发生率较高。所致ADR以变态反应居多,其中过敏性休克22例(占33.33%),过敏反应15例(占22.73%);其次为循环系统,共10例(占15.15%)。结论:清开灵注射液引起ADR的原因较多,临床应加以重视。特别是西医在应用该药时,更应加强监测,坚持合理用药,以减少ADR的发生。     

Epidemiology of alternaria alternata allergy: a prospective study in 6840 Italian asthmatic children

BACKGROUND: The prevalence of Alternaria Alternata (AA), a mold causing in children severe asthma is scarcely known, also due to the underdiagnosis of AA allergy, frequently due to multiple sensitizations to molds. OBJECTIVE: To analyze this issue we prospectively studied all children attending our Division between January 4, 1990 and December 31, 1997. METHODS: A total of 6840 children with asthma or allergic rhinitis were evaluated. Diagnosis was established by family and personal history, physical examination, skin prick tests (SPTs) and RAST (Radio Allergo-Sorbent Test) for inhalants including AA. We further evaluated: (1) sensitization only to AA allergens without positivity for additional inhalants; (2) prevalence of AA positivity among children with asthma or allergic rhinitis; (3) concordance between SPTs and RAST for allergy to molds, (4) proportion of children treated with specific immunotherapy (SIT). RESULTS: Among the 6840 children 213 were positive to AA (3.3%), only 89/6840 children (1.3%) had AA monosensitization (p = 0.0001), a concordance between SPTs and RAST was present in 21/89 (23.6%) children (p = 0.0009), and only 9 children out of 89 were SIT treated. Concerning the clinical manifestations, 83 had asthma or allergic rhinitis, and 6 had asthma associated with atopic dermatitis. Family history was positive in 82.9% of children. The mean onset of AA sensitivity was at age 4 for males, and at age 5 for females. CONCLUSIONS: In childhood, AA allergy is a genetic affection. The SPT concordance with history and clinical examination appears to be operative. Due to life-threatening reactions in children with AA allergy, we suggest that those with suspected inhalant allergy be tested with AA allergens, and treated with SIT if positive.