Allergische Arzneimittelreaktionen der Haut: Aktuelles zu Klinik, Diagnostik und Differenzialdiagnostik

Zusammenfassung

Wesentliche Änderungen im Verständnis und Management allergischer Arzneimittelreaktionen in den letzten Jahren resultieren in der zunehmenden Bedeutung der Biologics, deren Spektrum an unerwünschten Reaktionen und ihnen zugrunde liegenden Mechanismen sich in vielen Fällen von den klassischen, kleinmolekularen „covalent drugs“ unterscheiden. Antibiotika stellen bis heute die häufigste Ursache dar für allergische Erkrankungen wie Urtikaria und Arzneimittelexanthem. Bei ß-Lactam-Antibiotika stehen zunehmend Seitenkettenallergien – insbesondere auf Ampicillin und Amoxycillin, neuerdings auch Clavulansäure – im Vordergrund. Fluorchinolone spielen vor allem als Ursache anaphylaktischer Reaktionen und fotoallergischer Reaktionen eine Rolle. Vor allem bei allergischen Reaktionen auf NSAIDs müssen pseudoallergische Reaktionen differenzialdiagnostisch unterschieden werden. Bei schweren Arzneimittelreaktionen stehen Medikamente wie Allopurinol und Antikonvulsiva im Vordergrund. Sowohl bei AGEP wie auch der pustulösen Psoriasis werden Mutationen im Gen des IL36 R gefunden, was die differenzialdiagnostische Trennung erschwert, wenn nicht die Eigenständigkeit des AGEP von einer provozierten pustulösen Psoriasis in Frage stellt.

Abstract

A new trend in our understanding and in the management of drug hypersensitivity reactions is the increasing importance of biologics which differ in their spectrum of adverse drug reactions from the covalent drugs. With regard to covalent drugs ampicillin and amoxycilline as well as clavulinic acid play an increasing role among ADRs of ß-lactam-antibiotics. Fluorquinolones are mainly the cause of anaphylactic reactions and photosensitivity. In opposite to the main cutaneous allergic drug reactions such as urticaria or skin rash, in which antibiotics are the main culprits, severe drug allergic reactions such as SJS, TEN, or DRESS compounds like allopurinol and anticonvulsants are the main causes. Similar mutations in the IL36 R gene in AGEP and pustular psoriasis make differential diagnoses more difficult if there is a difference between these diseases and if AGEP is not just a drug induced pustular psoriasis.

• Literatur

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