Mẫn cảm chéo và phản ứng da liên quan tới thuốc chống động kinh có vòng thơm

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Tác giả: Thị Minh Hương Lê, Văn Đĩnh Nguyễn, Văn Khiêm Nguyễn, Văn Quang Vũ

Ngôn ngữ: Vie

Ký hiệu phân loại:

Thông tin xuất bản: Nhi khoa 2023

Mô tả vật lý: 21-26

Bộ sưu tập: Metadata

ID: 406301

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Tóm tắt
Chủ đề

Động kinh là một bệnh lý hay gặp của hệ thần kinh. Tỷ lệ bệnh nhân động kinh ước tính khoảng 1% dân số. Các thuốc chống động kinh (AEDs - antiepileptic drugs) giúp kiểm soát tốt các cơn động kinh, tuy nhiên một số phản ứng quá mẫn với AEDs cũng đã được ghi nhận. Các tác dụng phụ của AEDs gồm có các biểu hiện sớm (buồn ngủ, chóng mặt, các biểu hiện ở dạ dày ruột, thậm chí làm co giật nặng lên) và các biểu hiện muộn (các đợt loạn thần, các rối loạn hành vi, trầm cảm, suy giảm nhận thức, loãng xương, giảm bạch cầu). Các phản ứng trên da thuộc nhóm các biểu hiện sớm, từ các phản ứng nhẹ như phát ban da (MPE), tới các phản ứng da nặng (SCARs) bao gồm Hội chứng Steven-Johnson (SJS), hoại tử thượng bì nhiễm độc (TEN), phản ứng với thuốc có triệu chứng toàn thân có tăng bạch cầu ái toan (DRESS) và ban mụn mủ cấp tính toàn thân (AGEP). Việc sử dụng các thuốc chống động kinh có vòng thơm (aromatic) như Carbamazepine, Oxcarbazepine, Phenytoin, Phenobarbital, Lamotrigine, Primidone và Zonisamide thường có liên quan tới phát ban trên da và các triệu chứng, dấu hiệu khác của quá mẫn do thuốc. Bệnh nhân bị phản ứng dị ứng hoặc quá mẫn với AEDs có tỷ lệ mẫn cảm chéo cao (40-80%), điều này gợi ý rằng cần tránh các thuốc chống động kinh có cấu trúc hóa học tương đồng ở những quần thể có nguy cơ cao., Tóm tắt tiếng anh, Epilepsy is a disease common in the nervous system. The prevalence of epilepsy is estimated at 1% of the population. Antiepileptic drugs (AEDs) provide good control of seizures, but some hypersensitivity reactions to AEDs have also been reported. Side effects of AEDs include early manifestations (drowsiness, dizziness, gastrointestinal symptoms, even worsening of convulsions) and late manifestations (psychotic episodes, behavioral disturbances, depression, cognitive impairment, osteoporosis, leukopenia). Cutaneous adverse reactions that fall under the category of early manifestations, ranging from mild reactions such as skin rashes (MPE), to severe cutaneous adverse reactions (SCARs) include Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis). (TEN), symptomatic systemic drug reactions with eosinophilia (DRESS) and acute systemic pustular rash (AGEP). The use of aromatic antiepileptic drugs such as Carbamazepine , Oxcarbazepine, Phenytoin, Phenobarbital, Lamotrigine, Primidone and Zonisamide are often associated with skin rash and other symptomsand signs of drug hypersensitivity. Patients with allergic reactions or hypersensitivity to AEDs have a higher incidence cross-sensitization is high (40- 80%), which suggests that chemically structer similar antiepileptic drugs should be avoided in high-risk populations.

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