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Lyfjaofnæmi og lyfjaóþol meðal 20-44 ára Íslendinga : faraldsfræðileg könnun

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Authors
Halla Skúladóttir
Davíð Gíslason
Þórarinn Gíslason
Issue Date
1997-11-01

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Other Titles
Allergic and pseudo-allergic reactions to drugs in an Icelandic urban population 20-44 years of age
Citation
Læknablaðið 1997, 83(11):726-30
Abstract
Objective: Allergic or pseudo-allergic reactions to drugs are common complaints. The symptoms vary from mild to life threatening. Although the mechanisms for most drug reactions are unknown or uncertain such reactions are believed to be more common among atopic individuals. Our goal was: 1) To estimate the prevalence of allergic and pseudo-allergic drug reactions in a random urban Icelandic population 20-44 years of age. 2) To search for the characteristics of symptoms and which drugs were involved in such reactions, 3) their association to atopy and atopic diseases and 4) to find possible risk factors. Material and methods: In the second stage of the European Community Respiratory Health Survey an urban population 20-44 years of age was invited to participate. In Iceland altogether 545 answered an additional question: Have you at any time had allergic reaction to drugs? Those who answered yes to this question were contacted later by telephone and asked further about drug allergy. Results: Altogether 77 (14%) replied yes to the question, more females (19%) than males (9%) (p<0.001). Atopic individuals (with one or more positive prick tests) and those with nasal allergies, eczema, urticaria and illness caused by eating a particular food or foods reported allergic drug reactions more often (p<0.05). IgE geometric mean value was 17.5 kU/L for those who reported allergic drug reaction compared to 12.6 kU/L among the others (p=0.08). The most common symptoms associated with drugs were skin symptoms (urticaria, angioneurotic edema), symptoms from respiratory organs and fever. With further inquiries by telephone 13/64 denied drug allergy. Thus 51/64 (80%) withheld their questionnaire answers. Antibiotics were most often blamed for drug reactions, followed by anaesthetics, NSAID and opiates. Conclusion: There was a correlation between reported drug reactions and atopy and/or atopic diseases. The drug reactions were more than twice as common in women as in men. The only comparable study we know of, shows the prevalence of drug reactions on the same level as in Iceland.
Inngangur: Kvartanir um lyfjaofnæmi eru algengar og geta verið af ýmsum toga; allt frá því að vera smávægileg óþægindi til lífshættulegs ástands. Þótt eðli flestra lyfjaviðbragða sé óþekkt er talið að einstaklingar með bráðaofnæmi (atopy) og/eða aðra ofnæmissjúkdóma (atopic diseases) fái þau frekar en aðrir. Markmið þessarar rannsóknar var: 1) að kanna hversu algengt væri að þéttbýlisfólk á aldrinum 20-44 ára teldi sig hafa lyfjaofnæmi, 2) að kanna hvaða einkenni og lyf tengdust meintu lyfjaofnæmi, 3) að kanna tengsl lyfjaofnæmis við ofnæmi og ofnæmissjúkdóma og 4) meta áhættuþætti. Efniviður og aðferðir: í öðrum áfanga rannsóknarinnar Lungu og heilsa var íbúum á Reykjavíkursvæðinu á aldrinum 20-44 ára boðið til þátttöku. Spurt var viðbótarspurningar um lyfjaofnæmi og samtals svöruðu 545 spurningunni: Hefur þú fengið ofnæmiseinkenni af lyfjum? Nokkru síðar var aftur haft samband við þá sem svöruðu spurningunni játandi og þeir spurðir nánar um lyfjaofnæmi. Niðurstöður: Sjötíu og sjö (14%) svóruðu spurningunni játandi. Tvöfalt fleiri konur (19%) en karlar (9%) töldu sig hafa lyfjaofnæmi (p<0,001). Einstaklingar með bráðaofnæmi (með jákvætt húðpróf fyrir einum eða fleiri ofnæmisvökum) og ofnæmissjúkdóma á borð við ofnæmiskvef, exem, ofsakláða og ofnæmi fyrir mat töldu sig oftar hafa lyfjaofnæmi en aðrir (p<0,05). Meðalgildi (geometric mean value) E-ónæmisglóbúlíns (IgE) mældist 17,5 kU/L hjá þeim sem töldu sig hafa lyfjaofnæmi en 12,6 kU/L hjá þeim sem ekki töldu sig hafa lyfjaofnæmi (p=0,08). Langalgengustu einkennin tengd lyfjaofnæmi voru frá húð (ofsakláði, ofsabjúgur), en þar næst komu einkenni frá öndunarfærum. Hita nefndu 8%. Með símaviðtali náðist til 64 einstaklinga og þá fækkaði þeim um 13 sem í fyrstu töldu sig hafa lyfjaofnæmi. Þannig stóð eftir 51 eða 80%. Sýklalyf var sá flokkur lyfja sem oftast var talinn valda ofnæmiseinkennum en þar næst komu svæfingarlyf, gigtarlyf og ópíumefni (opiates). Umræða: í könnuninni kom fram fylgni milli bráðaofnæmis, ofnæmissjúkdóma og lyfjaofnæmis. Meira en helmingi algengara var að konur teldu sig hafa lyfjaofnæmi en karlar. Í þeirri einu sambærilegu rannsókn sem við fundum var tíðni ofnæmiseinkenna af lyfjum svipuð og hér á landi.
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