Abstracts
Résumé
Les allergies médicamenteuses représentent une part non négligeable de la pathologie iatrogène. Leurs manifestations sont multiples, allant d’une urticaire localisée au grand choc anaphylactique ou au décollement cutané parfois mortels. Leurs mécanismes sont variés et leurs diagnostics trop rarement confirmés. Les réactions immédiates, de type urticaire/angioedème, par exemple, sont souvent de mécanisme dépendant des Ige lorsqu’elles sont de nature allergique. Les réactions non immédiates, de type érythème maculo-papuleux par exemple, impliquent l’activation de lymphocytes T spécifiques lorsqu’elles sont de nature allergique. Il n’existe pas de réelles études épidémiologiques démonstratives ayant été complétées par un bilan allergologique. Or, de nombreuses réactions revêtent les symptômes d’une allergie, mais ne sont pas de mécanisme allergique. La réalisation d’un bilan exhaustif lors de ces réactions permettrait d’améliorer nos connaissances sur leur fréquence et leurs mécanismes. Cet article analyse les études épidémiologiques incluant les données d’incidence et de mortalité, et aborde les avancées récentes concernant la physiopathologie et le diagnostic des allergies médicamenteuses.
Summary
Drug hypersensitivity reactions frequently occur in hospitalized and out-patients. Clinical presentations are numerous and heterogeneous, from a mild urticaria to a dramatic anaphylactic shock and an extensive bullous skin disease. Allergic reactions are unpredictable reactions, related to immunologic mechanisms. Some reactions mimic allergic reactions but no drug specific antibody or T cell proliferation can be demonstrated. A true diagnosis is rarely set up and the tools for it are lacking. In this review, we will focus on the available epidemiological data concerning these reactions, including data on incidence and mortality and on the most recent advances in the pathophysiology and allergy diagnosis of drug hypersensitivity reactions.
Appendices
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