静脉滴注维生素K1致过敏反应3例及药学干预

3例肾内科患儿拟行肾穿刺术接受维生素K110 mg静脉滴注预防穿刺部位出血,用药后1～5 min出现胸闷、喘憋、呼吸困难、皮疹等过敏反应。立即停用维生素K1,过敏反应相关症状于停药后10～20 min消失。本文分析了过敏反应发生的原因,并实施了有效的药学干预。     

诃子提取物的皮肤过敏性及阴道刺激性研究

目的 通过研究诃子提取物对豚鼠的毒性作用开发诃子提取物新的制剂.方法 ①主动皮肤过敏实验:豚鼠27只按体重随机分成3组,每组9只,即诃子提取物组(40 mg/0.5 ml/kg)、生理盐水空白对照组(生理盐水0.5 ml/只)与1% 2,4二硝基氯代苯阳性对照组,剂量为0.5 ml/只,豚鼠经皮肤多次给药致敏后,观察其过敏反应.②阴道刺激性试验:取豚鼠12只按体重随机分成2组,每组6只,即诃子提取物组(40 mg/kg)、和赋形剂对照组(生理盐水对照),经阴道给药,观察其全身状态有无异常及阴道组织有无红斑和水肿等.结果 豚鼠给药后未发生皮肤过敏反应;经阴道给药后阴道组织正常,无红斑和水肿出现,同时全身状态无明显变化.结论 诃子提取物对豚鼠皮肤无过敏反应,对豚鼠全身及阴道局部无不良毒性反应,可以进一步开发新的外用型制剂.     

注射用头孢哌酮钠过敏反应1例

患者 ,女 ,2 4岁。主因一胎孕足月头位 ,阴道流水 2h ,不规律宫缩 40min入院。查 :T 3 7.4,P 88次 min ,BP 12 0 80mmHg。浮肿 ( +) ,因骨盆出口狭窄行剖宫产术。既往无过敏史。术后青霉素皮试阴性 ,给予 0 .9%生理盐水加头孢哌酮钠 0 .3g静脉滴注 ,液体输入约 10 0ml时 ,患者面部及双耳水肿、胸闷、呼吸发憋、声嘶 ,P 118次 min ,BP 12 0 75mmHg。立即停止输液 ,给吸氧 ,氟美松 10mg入壶 ,10min后患者病情好转 ,3 0min后呼吸平衡 ,根据发病时及症状诊断为头孢哌酮钠过敏反应。讨论　注射用头孢哌酮钠是白色结晶性粉末 ,易溶于水 ,…     

宫颈炎栓致过敏反应1例

患者 ,女 ,30岁。临床诊断 :慢性宫颈炎。给予宫颈炎栓(广西敬修堂药业股分有限公司生产 ,批号 :0 0 0 91 5) ,当晚入睡前将 1枚宫颈炎栓剂塞入阴道。 3ｈ后感觉阴道内奇痒 ,不能入睡 ,第 2天来医院就诊。临床检查 :阴道粘膜充血、水肿。考虑为宫颈炎栓所致过敏反应。嘱停药。做阴道冲洗 ,口服马来酸氯苯那敏 4ｍｇ,ｐｏ,ｔｉｄ ,维生素Ｃ 0 .2ｇ ,ｐｏ ,ｔｉｄ,葡萄糖酸钙 1 .0ｇ,ｐｏ,ｔｉｄ。2ｄ后症状消失。 1 9ｄ后 ,该患者又自行使用此药 ,约2ｈ后又重现上述症状 ,经及时对症处理 ,症状再次逐渐消失。宫颈炎栓的主要成分为合成鱼腥草素和冰片。其中鱼腥草具有抗炎消肿、清热解毒、促进组织再生等作用。冰片具有消炎镇痛、收敛作用。二者不良反应极少见。本例患者自述 ,用药前未用过其他药物 ,无其他接触史 ,故可排除其他致敏因素。建议妇科阴道用药时 ,同时配发阴道冲洗器 ,便于用药前洗净阴道 ;若发生药敏反应能及时将药物冲出。宫颈炎栓致过敏反应1例@李玮$陕西飞机制造公司第二职工医院药剂科!城固723213宫颈炎栓;;过敏反应     

59例复方丹参注射液致过敏反应的文献分析

目的通过对59例复方丹参注射液致过敏反应的文献进行分析,探讨其引起过敏反应的机制和特点,为临床安全合理用药提供参考。方法对1994年～2013年中国期刊全文数据库文献进行检索,对其中涉及复方丹参注射液致过敏反应的42篇文献中报道的59例病例报告进行统计与分析。结果复方丹参注射液致过敏反应对性别无差异,以中老年患者为主;过敏反应出现时间最短为用药后2min,最长为连续用药16d后出现,大多集中在药后30min内发生;过敏反应累及多个系统一器官,临床表现复杂多样,主要有皮肤及附件损害、呼吸系统、胃肠道系统、全身性损害、神经系统、心血管系统,其中以心血管系统为主,占27．05％;所有病例均发现及时,立即停药,进行对症处理,治疗和预后良好,未见死亡病例报道。结论临床医师与药师应重视复方丹参注射液所致过敏反应的发生,加强临床监测,以减少不良反应的发生。     

复方妇康安阴道泡腾片的毒理学研究

目的 :研究复方妇康安阴道泡腾片 (FKA)对家兔和豚鼠的毒性作用。方法 :家兔分别采用单次及多次阴道给药 ,进行急性毒性和刺激性实验 ,观察其全身状态有无异常及阴道组织有无红斑和水肿等 ;豚鼠则进行皮肤过敏性实验。结果 :家兔给药前、后全身状态无明显变化 ,刺激反应评分为0 ;豚鼠给药后未发生皮肤过敏反应。结论 :FKA对家兔和豚鼠安全、无毒。     

CT增强扫描造影剂过敏反应12例报告

我院1997年2月至1998年10月进行的CT增强扫描400例中,发生12例过敏反应,现报告如下。1 临床资料1.1 一般资料 12例过敏反应患者,男7例,女5例;年龄最大76岁,最小12岁。全部患者造影前经碘静脉过敏试验阴性,造影前常规静脉注射地塞米松10mg。1例于注药3min后发生,其他11例在注药后40min内发生,其中轻、中度碘过敏反应10例,表现为恶心、呕吐、皮肤发热、散在荨麻     

克霉唑栓局部刺激性和过敏性（Buehler法）试验

目的评价克霉唑栓局部刺激性和过敏性。方法以克霉唑栓囊芯家兔阴道给药,观察其对家兔完整和破损阴道粘膜的刺激性;Buehler法豚鼠阴道给予克霉唑栓观察其过敏性。结果刺激性试验期间,克霉唑栓组动物饮食、活动均正常,无死亡现象,动物阴道粘膜表面光滑亮泽,无水肿、出血点、溃疡或异常增生,阴道粘膜刺激性反应与基质栓组比较差异无显著性意义;病理学检查结果,克霉唑栓组动物阴道内膜完整,上皮呈高柱状,无坏死脱落和大量炎性细胞,与基质栓组比较无明显差异;过敏性试验期间,克霉唑栓组动物阴道无红斑或水肿等过敏反应症状,致敏率为0％,表明克霉唑栓对豚鼠阴道无致敏性,也未见哮喘、站立不稳或休克等严重的全身性过敏反应,与基质栓组比较差异无显著性意义。结论克霉唑栓对阴道粘膜无明显的刺激性和致敏性。     

以腹痛为前驱症状的青霉素过敏反应35例报道

青霉素为临床常用抗生素之一 ,过敏反应较常见 ,但以腹痛为前驱症状的青霉素过敏反应报道甚少。本文对以腹痛为前驱症状的 35例患者进行了研究。青霉素 G钠 4 80万 u加入生理盐水 10 0 ml中静滴 ,每日 2次 ,用药前青霉素皮试均阴性。静滴 2～ 10 min后 ,出现腹痛 ,继而恶心、头痛 ,喉头发痒、心慌、全身皮肤及外阴部瘙痒等症状 ,30例调慢输液速度 10 min后 ,症状缓解。5例给予地塞米松等药 ,其中 3例 5 min后症状消失。另 2例 ,肌注 2 5 mg异丙嗪 30 min症状缓解。结论 :目前青霉素在临床应用中有浓度高、速度快的趋势 ,故皮试阴性后过敏现象增多。出现腹痛 ,可能与短时间内大剂量药物直接进入血液循环 ,引起胃肠道粘膜充血、水肿导致平滑肌痉挛等有关。控制输液速度 ,可有效地降低过敏反应的发生。     

丁二磺酸腺苷蛋氨酸致呼吸困难

1例54岁男性乙型肝炎后肝硬化患者,因胆红素升高,首次接受丁二磺酸腺苷蛋氨酸1000 mg加入5%葡萄糖注射液250 ml静脉滴注治疗.5 min后,患者出现胸闷、憋气、呼吸困难,口唇紫绀,双肺哮鸣音.T 37.0℃,R 30次/min,HR 120次/min,BP 125/82 mmHg.考虑为丁二磺酸腺苷蛋氨酸引起的过敏反应,立即停药,给予鼻管吸氧及肾上腺素治疗后好转.作者认为,丁二磺酸腺苷蛋氨酸所致过敏反应少见,临床应用该药应予以注意.     

Anaphylactoid reaction caused by intravenous doxycycline during general anesthesia and beta-blockade treatment

A 71-year-old woman with icterus was treated with doxycycline orally for one week. She then was admitted for an exploratory laparotomy under general anesthesia with barbiturate, pancuronium, fentanyl, and nitrous oxide. She developed rapid atrial fibrillation and received digitoxin and beta-blockade. Thirty minutes after her last medication she received doxycycline 100 mg in 200 ml sodium chloride 0.9% infused over five to ten minutes. Soon after the completed infusion, she developed a severe anaphylactoid reaction with bronchospasm, hypotension, and generalized urticaria, which was treated successfully with ephedrine, aminophylline, hydrocortisone, furosemide, metaraminol, ketamine, and epinephrine. The possibility of beta-blockade treatment worsening the reaction is discussed and five other reports of anaphylactoid reactions to intravenous doxycycline are mentioned.     

曲妥珠单抗引起过敏样反应

1例52岁女性患者,因乳腺癌术后辅助化疗给予曲妥珠单抗220mg加入0.9%氯化钠注射液250ml静脉滴注,滴速为50滴/min。输入约30min时,患者出现寒战、胸闷、口唇发麻、呼吸困难,心率165次/min,血压199/99mm Hg。立即停止输液,行对症治疗。50min后上述症状消失,心率及血压恢复正常。21d后再次化疗,曲妥珠单抗110mg加入0.9%氯化钠注射液250ml静脉滴注,滴速30滴/min。5min后,患者再次出现过敏样症状。停药10min后症状消失。     

Enzyme therapy in Fabry disease: severe adverse events associated with anti-agalsidase cross-reactive IgG antibodies

AIMS

To report a severe adverse event related to enzyme replacement therapy with agalsidase in an hemizygous male patient treated for Fabry disease.

METHODS

Retrospective analysis of clinical, radiological and biochemical data in a patient who suffered adverse events related to both agalsidase alfa and agalsidase beta treatments.

RESULTS

A hemizygous male patient was first treated for Fabry disease with agalsidase alfa. After more than 1 year of therapy, infusion-related symptoms necessitated systemic steroids and antihistaminic therapy. Decline in kidney function prompted a switch for agalsidase beta. Anaphylactoid shock occurred after the second infusion. No serum IgE antibodies were disclosed. Skin-test reactivity to agalsidase beta was negative. Following a published rechallenge infusion protocol, agalsidase beta was reintroduced, leading to a second anaphylactoid shock episode. Enzyme replacement therapy was stopped and the patient was treated with symptomatic therapy only. This case was referred to the pharmacovigilance department.

CONCLUSION

The negativity of immunological tests (specific anti-agalsidase IgE antibodies and skin tests) does not rule out the risk of repeated anaphylactoid shock following agalsidase infusion.     

Potential anaphylactic shock with abciximab readministration

A 46-year-old woman developed an anaphylactic reaction during percutaneous coronary intervention after she was pretreated with prednisone and diphenhydramine for a known allergy to iodine. She developed pruritus, edema, and nausea, which were followed by bradycardia and shock, minutes after administration of a bolus and standard-dose infusion of abciximab. The reaction was treated successfully with epinephrine, methoxamine, hydrocortisone, atropine, furosemide, sodium bicarbonate, diphenhydramine, and ranitidine.     

73例头孢菌素类药物严重不良反应分析

目的：了解头孢菌素类药物引起的严重不良反应（SADR）的发生规律,发掘药物警戒信号,为临床安全合理用药提供参考。方法：收集武汉市不良反应监测系统数据库中2009～2011年头孢菌素类严重的（包括新的严重的）不良反应报告,从中筛选出符合标准的73例进行分析。结果：73例SADR涉及头孢菌素19个品种,其中以头孢曲松的比例最高;临床表现以过敏性休克和过敏样反应为主的全身性损害最为突出;41例SADR发生时间在30min内;50岁以上的老年人及10岁以下儿童ADR构成比较高。从ADR病例报告中反映存在相当数量的不合理用药现象。结论：临床应高度重视头孢菌素类药物引起的过敏性休克等SADR,增强合理用药意识,以减少和避免SADR的发生。     

7种中药注射剂对Beagle犬类过敏反应研究

 目的：选择临床报告过敏性休克排名较前的7种中药注射剂进行Beagle犬类过敏反应试验（anaphylactoid reaction）,并探讨聚山梨酯80（Tween 80）对中药注射剂致敏性的影响。方法：通过一次静脉恒速注射各种中药注射剂,观察Beagle犬的反应症状,检测血浆中组胺、免疫球蛋白E （immunoglobulin E,IgE）、免疫球蛋白G（immunoglobulin,IgG）和免疫球蛋白M （immunoglobulin M,IgM）含量。结果：根据行为症状和组胺含量升高综合判断为类过敏反应强阳性者有含Tween 80的鱼腥草、脉络宁和复方丹参注射剂,其他为阳性。结论：7种中药注射剂均出现类过敏反应,吐温80是导致含Tween 80的中药注射剂类过敏反应的主要诱因之一,但非惟一原因,尚存在一些其他诱发物质,需进一步研究。     

奥沙利铂引发过敏性休克

1名52岁男性结肠癌患者,术后给予奥沙利铂(乐沙定)150mg。第5疗程患者在应用奥沙利铂(艾恒)后出现咳嗽和皮肤潮红。第6疗程静脉滴注奥沙利铂(乐沙定)10min后患者出现皮肤潮红、瘙痒、咳嗽、呼吸困难及低血压(63/45mmHg),诊断为过敏性休克,经对症治疗后缓解。     

香菇多糖注射液致过敏性休克1例

1例51a男性患者,因右肺腺癌纵隔淋巴结转移7个月,为增强免疫力给予香菇多糖注射液2mg加0.9%氯化钠注射液100mL静脉滴注。输注约3min后患者出现胸闷、心慌、呼吸困难、短暂性意识丧失,BP110/60mmHg,P110次·min-1,立即停药吸氧,并给予地塞米松等治疗,20min后患者恢复正常。     

注射用奥美拉唑钠致过敏性休克1例

1例63a男性患者,因慢性浅表性胃炎给予注射用奥美拉唑钠40mg＋5%葡萄糖氯化钠注射液100mL,在静脉滴注约10min后,患者头面部及四肢出现皮肤瘙痒、胸部不适、面色苍白、意识模糊,BP50/30mmHg,HR50次·min-1,考虑为过敏性休克,立即停药,给予吸氧及多巴胺、阿托品、地塞米松治疗,10min后,患者神志转清,症状逐渐好转。     

Histamine metabolism after adverse reactions due to d-tubocurarine administration

We investigated histamine release in five female patients, submitted for gynaecological surgery, after intravenous administration of the neuromuscular blocking agent d-tubocurarine. In these patients, we measured the plasma levels of histamine and its metabolites, N tau-methylhistamine and N tau-methylimidazoleacetic acid, making use of mass fragmentographic methods. The newly developed determination of plasma N tau-methylimidazoleacetic acid had a within-day coefficient of variation of 2.7% (n = 10). Normal values of N tau-methylimidazoleacetic acid in plasma ranged from 41.3-75.6 nmol/l (n = 13). All five patients developed anaphylactoid reactions: two patients showed severe systemic reactions, one patient a minor systemic reaction and two had skin reactions only. Plasma histamine and N tau-methylhistamine levels appeared to be the most reliable biochemical parameters for confirming both the occurrence and severity of an anaphylactoid reaction. In comparison with plasma histamine, the determination of plasma N tau-methylhistamine is less hampered by artefacts caused by blood collection and plasma preparation. Together with the fact that the increase in plasma N tau-methylhistamine levels after anaphylactoid reactions lasts much longer than the increase in plasma histamine levels, this leads to the conclusion that the determination of plasma N tau-methylhistamine is a useful retrospective parameter for histamine release in this type of pathological state. The plasma N tau-methylimidazoleacetic acid levels fluctuated considerably, showing only a significant increase after administration of d-tubocurarine in the two patients who had severe anaphylactoid reactions. This parameter is, therefore, less useful in such studies.