INVESTIGATION OF MEDICALLY INDUCED SKIN REACTIONS BASED ON THE ANALYSIS OF REPORTS OF ADVERSE DRUG REACTIONS IN THE REPUBLIC OF CRIMEA (FROM 2009 TO 2016)

Drug hypersensitivity reactions are among the most important problems that arise when using drugs. The occurrence of such reactions in the population is at least 7% and tends to a constant increase. The most frequent manifestations of drug hypersensitivity reactions are medically induced skin lesions.

The aim of this research was to study and analyze the cases of development of skin drug reactions on the basis of the reports on the adverse reactions (ADRs) of the drugs, registered in the Republic of Crimea in the period from 2009 to 2016.

Materials and methods. The objects of the research were report cards about the adverse reactions, registered in the regional base (registry) of spontaneous messages called ARCADe (Adverse Reactions in Crimea, Autonomic Database) for the period from 2009 to 2016. During the analysis of the report cards, 2,698 cases of the development of skin drug reactions arising in response to the use of drugs in patients were selected. The study of the frequency of occurrence of skin drug reactions in the application of various groups of drugs was carried out taking into account the codes of the Anatomical Therapeutic Chemical (ATC) Сlassification System of drugs of the World Health Organization (WHO).

Results. Of the study showed that the development of skin drug reactions was most often associated with the use of antimicrobial agents for internal use, nonsteroidal anti-inflammatory drugs (NSAIDs), drugs for the treatment of diseases of the gastrointestinal tract and agents that affect the nervous system. Among the clinical manifestations of skin drug reactions, generalized and localized rashes prevailed, and itching and hyperemia of the skin were much less common in patients. The analysis of age categories showed that the most frequently medically induced reactions occurred in children from birth to 3 years, as well as in the age group of patients from 46 to 60 years. The risk factors identified in the course of the analysis, were female gender, early childhood and old age, as well as the presence of aggravated drug allergy history.

Conclusion. Drug hypersensitivity reactions create certain difficulties in clinical practice related to the diagnosis, treatment and prophylaxis, and may also cause danger to health or life of patients. In this connection, the study of such adverse reactions is the most important task of practical health care and requires direct participation of doctors of all specialties.

1. Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, Khan DA, Lang DM, Park HS, Pichler W, Sanchez-Borges M, Shiohara T, Thong BY. International Consensus on drug allergy. Allergy. 2014;69(4):420–37. https://doi.org/10.1111/all.12350.

2. Stepanova EV. Sovremennye aspekty diagnostiki i lecheniya lekarstvennoj allergii [Modern aspects of diagnosis and treatment of drug allergy]. Lechashhij vrach. 2009;4:17–24. Russian.

3. Macharadze DS. Giperchuvstvitel’nost’ k pishhevym napolnitelyam lekarstvennyh preparatov [Hypersensitivity to food fillers drugs]. Lechashhij vrach. 2014;1:68–74. Russian.

4. Ilina NI, Latisheva TV, Myasnikova TN, Luss LV, Kurbacheva OM, Erohina SM. Lekarstvennaya allergiya. Metodicheskie recomendacii dlya vrachey (Chast 2) [Drug allergy. Recommendations for clinicians (Part II)]. Russian Allergology Journal. 2013;6:25–40. Russian.

5. Lee A, Thomson J. Drug-induced reactions. In: Lee A, editor. Adverse Drug Reactions. 2nd ed. London: Pharmaceutical Press. 2006;126–55.

6. Rudyk MYa, Ezhova LG, Mirilashvili TSh, Kotovskaya YuV, Kobalava ZhD. Harakteristika lekarstvenno-inducirovannyh kozhnyh reakcij v mnogoprofilnom skoropomoshchnom stacionare [Drug induced skin reactions characteristics in multifield emergency hospital]. RUDN Journal of Medicine. 2012;1:46–50. Russian.

7. Matveyev AV, Krasheninnikov AE, Egorova EA. Rol «off-label» naznacheniy kak factora vozniknoveniya nezhelatelnykh pobochnykh reaktsiy na lekarstvennyye sredstva v pediatricheskoy praktike [The role of “off-label” prescriptions as a factor in the occurrence of unwanted adverse reactions to drugs in pediatric practice]. Clinical Practice in Pediatrics. 2018;13(4):18–24. DOI: 10.20953/1817-7646-2018-4-18-24.

8. ATC/DDD Index 2019. Available at: https://www.whocc.no/atc_ddd_index/.

9. Skoroshodkina OV, Luntsov AV. Lekarstvennaya allergiya pri provedenii antibiotikoterapii [Drug allergy in antibiotics using]. The Bulletin of Contemporary Clinical Medicine. 2013;6(3):60–7. Russian.

10. Thong BY, Mirakian R, Castells M, Pichler W, Romano A, Bonadonna P, Deleanu D, Kowalski M. A world allergy organization international survey on diagnostic procedures and therapies in drug allergy/hypersensitivity. World Allergy Organ J. 2011;4(12):257– 70. DOI: 10.1097/WOX.0b013e31823dc02c.

11. Andreeva I, Stetsiouk O. Allergicheskie reakcii na antibiotiki [Allergic reaction to antibiotics]. Clin Pharmacol Ther. 2013;22 (2):5–10. Russian.

12. Borch JE, Andersen KE, Bindslev-Jensen C. Cutaneous adverse drug reactions seen at a university hospital department of dermatology. Acta DermVenereol. 2006;86 (6):523–7. DOI: 10.2340/00015555-0153.

13. Nazimkin KE, Larina VN, Golovko MG, Mikhailusova MP, Kuznetsov PI, Nikitina JA. Kozhnye proyavleniya nezhelatenyh reackcij lekarstvennoj terapii v praktike vracha terapevta polikliniki [Cutaneous manifestations of adverse drug therapy reactions in practice of out patient primary care practitioner]. Medical alphabet. 2017;1(8):30–34. Russian.

14. Zborovskij AB, Tyurenkov IN, Belousov YuB. Neblagopriyatnye pobochnye ehffekty lekarstvennyh sredstv [Adverse drug side effects]. M.: MIA, 2008:656 p.

15. Allergic reaction to antibiotics. Recommendations for clinicians. Available at: http://www.antibiotic.ru/rus/all/metod/aballergy/02.shtml. Russian.