儿童的药物皮肤反应

36SEGALetalAlissaR.Segal,PharmD,PhCa,KevinM.Doherty,PharmDb,JohnLeggott,MDcandBarrettZlotoff,MDdaDepartmentofPharmacyPractice,MassachusettsCollegeofPharmacy&HealthSciences,Boston,Massachusetts;bTexomaMedicalCenter,Denison,Texas;cDepartmentofFamilyandCommunityMedicine,School-BasedHealthCenters;dDepartmentofDermatology,UniversityofNewMexicoHealthSciencesCenter,Albuquerque,NewMexico(adversedrugreactions);(children);(dermatology);(cutaneousreactions)CADR=cutaneousadversedrugreactionADR=adversedrugreactionFDA=FoodandDrugAdministrationECE=exanthematouscutaneouseruptionEM=erythemamultiformeFDE=fixeddrugeruptionNSAID=nonsteroidalantiinflammatorydrugSSLR=serumsickness–likereactionDHS=drughypersensitivitysyndromeSJS=Stevens-JohnsonsyndromeTEN=toxicepidermalnecrolysisAddresscorrespondencetoAlissaR.Segal,PharmD,PhC,MassachusettsCollegeofPharmacy&HealthSciences,DepartmentofPharmacyPractice,179LongwoodAve,Boston,MA02115-5896.E-mail:[e-mail]37PEDIATRICS2008131(CADR)(ADR)[1]ADR5.5%2.2%CADR[2,3]CADRADR[4]2.5%CADR12%CADR[58]CADRADR[47]CADR[9][10]80%β30%[11]62CADR8CADR[12]4%[13][14]CADRCADR(CADR)CADRCADRCADRCADRCADRADR[1520][1]Naranjo[18]4(1)(2)(3)(4)131CADR38SEGALetal1()/1()()()0.5cm2wk(aphthousstomatitis)(cankersore)5mm()()(/Wiekham’s()(exanthems)10.5cm0.5cm0.5cm0.5cm0.5cm[162326][23]39PEDIATRICS2008131CADR[21]ADR(FDA)[17](rash)[16,22](exanthems)[22][23]CADR[10][22]15mm[24]1CADR2CADRAB().[10222728]32wk2wk()EB[21222430]40SEGALetalADRAB[2729]AADRAA(2)B()ADR[27,29]()(2)[10,27]CARDBADR5CADR29[22]5[21,30](ECE)CADR[21,22](1)514d[22]5%10%ECEECEEB95%ECE[22](342)[21]H1[3234]()6[35]()()[21]15%25%1241PEDIATRICS2008131[36,37][38](5)IgE[39]()[40](34)(EM)1/39%32%(6wk)[4144]Sackesen[44]58%(119)25%()13%8%4%75%()3%Mortureux[41](20)31%(18)12()3[42,43,4547]()CARD[21,45]Apter[48]70%5()24h()()()()[21222430]4/%9.85.43.60.98.95.38.96.20.916.13.60003.602.72.700.909.8009.83.60004.501.81.80.91.8[31]42SEGALetal[47][48](loratadine)(cetirizine)[49,50](hydroxyzine)[47](doxepin)(10mg/3/d)H1H2[51][52,53][54](FDE)[22,55](6)FDE30min2mo[21,22,54](5)[22]345FDE[55]FDECADR(118)26%22%FDE6%[30]Ibia[5]EMFDE()[56]FDE43PEDIATRICS2008131[56]FDE[21]FDE[5762][59,60]FDE[63](NSAID)FDE[55,56][6466]FDE[22]FDEFDE[67]23[67]8%[22,6870][70]3[70]1824h(hydro-chlorothiazide)230min12d(6)(doxycycline)36210cmEM30min8h()(FDE)[2122305663]644SEGALetal[21,70]AB[75][76](SSLR)[22]SSLR13wk[21]7()()()NSAID()()(StJohn’swort)(()(sulfo-nureas)(B6)NSAID()UV()[2122247074]8(SSLR)EM(SSLR)13wk()()()()()[2122243079838595]114d[7074](7)[21,70]45PEDIATRICS2008131SSLR0.024%[7782]0.5%SSLRSSLR[83][84]SSLR[7881,8592]SSLRSSLR[9193](8)SSLR()[21,91]CADRCADR1/10001/10000[17,21,96,97][98]CADR(DHS)()[24]Stevens-Johnson(SJS)(TEN)DHSSJSTEN9DHS16wk[97,99,100]SSLR()[97]DHS[21,96,97]DHS[24]DHSSSLR9/%/%/wkDHS(30%50%9016)SJS486413210%NSAIDTENSJS436513230%NSAID()[2124101105]46SEGALetalDHS[99]SJSTENDHSDHS()()[21,9597,99,100]EMSJSTEN[16,101106]EMSJSTEN[16,104]EMFDEEM1224h[16,21,22,101,103,105,107]3(7)EM()[21,24,108111][110,112]0%10%EMSJS[16,21,22,96,97,101106,113,114]EM78SJS9()(8)SJS50%90%[103,107,113](SJSTEN)[98]11%27%()[98]TEN[21,22,101105,107,113,115117]47PEDIATRICS2008131(9)TEN30%(Nikolskysign)()TEN[118]10%SJSSJS/TEN[104](25%50%)90%TEN[113]TEN[117]CADR10CADR[11122]11AIDS2()2()[212748]12CADR[28,30,119]CADR()A()CADR15[28]CADR[12,13,120,121]48SEGALetalCADRCADR10CADR38CADRCADRMedWatch3500()1-800-FDA-1088(1-800-332-1088)CADRFDACADRFDACADR11CADR10%CADRCADR(12)Litt(DrugEruptionReferenceManual)[22](ThePocketbookofDrugEruptionsandInteractions)[25]1Cutaneousdrugreactioncasereports:fromtheworldliterature.AmJClinDermatol2003;4:511–5212MillerRR.AmJHospPharm1973;30:585–5923BigbyM,etal.JAMA1986;256:3358–33634KushwahaKP,etal.IndianJPediatr1994;61:357–3655IbiaEO,etal.ArchDermatol2000;136:849–8546vanderLindenPD,etal.JClinEpidemiol1998;51:703–7087Cirko-Begovic´A,etal.EurJClinPharmacol1989;36:63–658KramerMS,etal.JPediatr1985;106:305–3109JohnsonML,etal.JAmAcadDermatol1984;11:930–93610GruchallaR.JAllergyClinImmunol2000;105:S637–S64411PilzerJD,etal.AmJHealthSystPharm1996;53:2970–297512HuangSW,etal.ClinPediatr(Phila)1998;37:601–60713Martin-MunozF,etal.JInvestigAllergolClinImmunol1999;9:172–17714PrestonSL,etal.AmJHealthSystPharm1994;51:79–8415KarchFE,etal.ClinPharmacolTher1977;21:247–25416CouncilforInternationalOrganizationofMedicalSciences.PharmacoepidemiolDrugSaf1997;6:115–12717RoujeauJC,etal.NEnglJMed1994;331:1272–128518NaranjoCA,etal.ClinPharmacolTher1981;30:239–24419KramerMS,etal.JAMA1979;242:623–63220HutchinsonTA,etal.JAMA1979;242:633–63821ShinHT,etal.CurrProblPediatr2001;31:207–23422LittJ.DrugEruptionReferenceManual.NY:Parthenon;200023Taber’sCyclopedicMedicalDictionary.Philadelphia,PA:F.A.DavisCo;2003.Availableat::WBSaunders;200025LittJ.ThePocketbookofDrugEruptionsandInteractions.2nded.NY:Parthenon;200126RawlinsMD.BrMedJ(ClinResEd)1981;282:974–97649PEDIATRICS200813127AssemEK.Drugallergyandtestsforitsdetection.In:DaviesDM