Penicillin Allergy
Transcript of Penicillin Allergy
Penicillin Allergy
References
• Laurence L Brunton, John S. Lazo, Keith L Parker, Goodman&Gilman’s the pharmalogical basis of therapeutics 11th ed, 2006
• Abbas AK, Lichtman AH. Cellular and Molecular Immunology, 5th ed, 2003
• http://www.webmd.com/allergies/tc/penicillin-allergy-topic-overview Last Updated: July 07, 2009
Penicillin Allergy: Overview
• Penicillin antibiotics are the most common cause of drug allergies
• An allergic reaction that occurs when your body’s immune system overreacts to penicillin antibiotics
• The most common adverse effects noted with the penicillins
Penicillin Allergy: Overview
• may occur with any dosage form of penicillin.• Allergy to one penicillin exposes the patient to
a greater risk of reaction if another is given.• However, the occurrence of an untoward
effect does not necessarily imply repetition on subsequent exposures.
Manifestations of allergy to penicillins
Maculo-papular rash
Anaphylaxis
Stevens-Johnson syndrome
Exfoliative dermatitis
Serum Sickness
Vasculitis
Brochospasm
Fever
Urticarial rashHigh
Frequency
Low
Manifestations of allergy to penicillins
Maculo-papular rash
Anaphylaxis
Stevens-Johnson syndrome
Exfoliative dermatitis
Serum Sickness
Vasculitis
Brochospasm
Fever
Urticarial rash
• Sudden, severe hypotension
• Brochoconstriction
Sudden Death !!!
Manifestations of allergy to penicillins
Maculo-papular rash
Anaphylaxis
Stevens-Johnson syndrome
Exfoliative dermatitis
Serum Sickness
Vasculitis
Brochospasm
Fever
Urticarial rash เป็�นผื่��นมากจนทำ าให้�เก�ดลอกทำ��งตั�ว
Manifestations of allergy to penicillins
Maculo-papular rash
Anaphylaxis
Stevens-Johnson syndrome
Exfoliative dermatitis
Serum Sickness
Vasculitis
Brochospasm
Fever
Urticarial rash ผื่�วห้น�งอ�กเสบ
Manifestations of allergy to penicillins
Maculo-papular rash
Anaphylaxis
Stevens-Johnson syndrome
Exfoliative dermatitis
Serum Sickness
Vasculitis
Brochospasm
Fever
Urticarial rash ผื่��นลมพิ�ษ
Manifestations of allergy to penicillins
Maculo-papular rash
Anaphylaxis
Stevens-Johnson syndrome
Exfoliative dermatitis
Serum Sickness
Vasculitis
Brochospasm
Fever
Urticarial rash ผื่��นแดง, ตั !มน"นแดง
Manifestations of allergy to penicillins
Maculo-papular rash
Anaphylaxis
Stevens-Johnson syndrome
Exfoliative dermatitis
Serum Sickness
Vasculitis
Brochospasm
Fever
Urticarial rash
The most serious hypersensitivity reactions
• Anaphylaxis• Angioedema (ห้น�งตัา, ป็าก
บวม)
Hapten Carrier Complex
Mechanism of penicillin allergy
Penicillin
Hapten = Low molecular weight substances that are able to produce
an allergic response•By themselves they are unable to induce antibody formation.
Break down
Penicillin Isomers
Covalent bond tissue&plasma proteins
Immune Response
Table1: Classification of Penicillin Reactions
Classification Time of onset Mediators Clinical Signs
1. Early Reaction
•Type I Hypersensitivity
15-30 mins IgE mediated •Anaphylaxis
•Angioedema
•Urticaria
•Type II Hypersensitivity
Varies min to hour
IgG, complement •Hemolytic anemia
•Granulocytopenia
•Type III
Hypersensitivity
Varies, 4-8 hr IgG, IgM immune complexes
•Serum Sickness
•Vasculitis
2. Late Reaction
•Type IV
Hypersensitivity
24-72 hr Cytokines activate Tc cells causing direct cellular damage
Contact dermatitis
•Idiopathic Usually >72 hrs
Maculopapular rash
is observed occasionally in pharmacists, nurses, and physicians
who prepare penicillin solutions
Type I:Immediate/Anaphylactic Hypersensitivity
Hapten Carrier
Complex
ป็ฏิ�ก�ริ�ยาภู"ม�แพิ�เฉี(ยบพิล�นเริ(ยกว!า Anaphylaxis ซึ่*�งม(อาการิ• ลมพิ�ษ• ความด�นโลห้�ตัตั �า• ค�น• Angioedema
Type II: Antibody-dependent cytotoxic Hypersensitivity
Hapten Carrier Complex
IgG IgM
• Soluble antigens that can attach to cell membranes
3 mechanism1. Opsonization/ Phagocytosis2. Antibody dependent cell cytotoxicity
(ADCC)1. Classical Complement Pathway
Destruction of affected cell/tissuesโดยเฉพาะเซลล�เม็ ดเล�อดทำ�าให้�เกิ�ด• Immune hemolytic anemia (เม็ ดเล�อดแดงแตกิ)•Thrombocytopenia (เกิล ดเล�อดต��า)•Granulocytopenia (เม็ ดเล�อดขาวต��า)
Penicillin Isomers
Covalent bond tissue&
Plasma proteins
Type III: Immune complex mediated hypersensitivity
IgG IgM
Type III: Immune complex mediated hypersensitivity
Immune Complex deposited
in BV cell wall, tissues
1. Complement activation (Classical Pathway)
2. Activation of neutrophil/ Phagocytosis Tissue damage
4. Activation of platelet
3. Activation of mast cell by immune complex&by c3a, c5a (anaphylatoxin)
Neutrophil recruitment
Destructive enzymes And reactive oxygen
species
HistamineLeukotriene
Vasodilation
Microthrombi
Tissue Necrosis
Type III: Immune complex mediated hypersensitivity
Immune Complex deposited
in BV cell wall, tissues
1. Complement activation (Classical Pathway)
2. Activation of neutrophil/ Phagocytosis Tissue damage
4. Activation of platelet
3. Activation of mast cell by immune complex&by c3a, c5a (anaphylatoxin)
อาการิแพิ�ยา penicillin • Serum Sickness • Vasculitis• Fever• Rash
Management of drug allergy
• Identify most likely drugs (based on history).• Avoidance of identified drug or suspected drugs is essential.• Perform allergy skin tests (if available).• Avoid potential cross-reacting drugs (e.g. avoid Cephalosporins in penicillin-
allergic individuals).• Use alternative medications, if at all possible.• Desensitize to implicated drug, if this drug is deemed essential.(เริ��มให้�จาก dose
ตั �าๆภูายใตั�การิด"แลของแพิทำย/)