利福平和异烟肼致皮肤过敏反应及脱敏疗法的研究进展

doi:10.3969/j.issn.2095-3755.2018.04.019

摘要/Abstract

摘要：

利福平及异烟肼作为治疗结核病的核心药物,可发生迟发性皮肤过敏反应,甚至出现史蒂文斯-约翰逊综合征(SJS)、药物超敏反应综合征(drug-induced hypersensitivity syndrome,DIHS)等全身性重度过敏反应,威胁患者的生命安全。识别致敏药物、启动脱敏疗法成为保证抗结核药物治疗安全有效进行的关键。作者就利福平及异烟肼致皮肤过敏反应的机制、常见临床表现、致敏药物检测及脱敏治疗方案进行文献综述与分析总结,以期为两种药物临床脱敏治疗提供一定参考。

关键词: 利福平, 异烟肼, 药物过敏, 超敏反应,迟发型, 脱敏法,免疫, 综述

Abstract:

Rifampicin and isoniazid, as the core drugs for the treatment of tuberculosis, can cause delayed allergic reactions, even severe adverse reactions such as Stevens-Johnson syndrome (SJS), drug-induced hypersensitivity syndrome (DIHS) and other severe allergic systemic symptoms, threatening the life safety of patients. Identification of allergenic drugs and implementation of desensitization therapy have become the key to safe and effective anti-tuberculosis therapy. In this article, we made a comprehensive literature review, and analyzed and summarized the sensitizing mechanisms of rifampicin and isoniazid in skin anaphylaxis, the common clinical manifestations, the detection of sensitizing drugs and the desensitization therapeutic scheme, so as to provide references for the desensitization treatment of these two drugs.

Key words: Rifampin, Isoniazid, Drug hypersensitivity, Hypersensitivity, delayed-type, Desensitization, immunology, Review

熊朝刚,任斐,吕小会,任磊鹏,周俊,李颖. 利福平和异烟肼致皮肤过敏反应及脱敏疗法的研究进展[J]. 结核病与肺部健康杂志, 2018, 7(4): 323-327. doi: 10.3969/j.issn.2095-3755.2018.04.019

Chao-gang XIONG,Fei REN,Xiao-hui LYU,Lei-peng REN,Jun ZHOU,Ying LI. Research progress of desensitization therapy and cutaneous adverse drug reactions induced by rifampicin and isoniazid[J]. Journal of Tuberculosis and Lung Health, 2018, 7(4): 323-327. doi: 10.3969/j.issn.2095-3755.2018.04.019

图/表 2

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参考文献 35

[1]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012,34(8):485-508.
[2]	吴小梅, 蔡颖, 刘巍 . 抗结核药物致超敏反应综合征.17例. 四川医学, 2015,36(11):1581-1583. doi: 10.16252/j.cnki.issn1004-0501-2015.11.029 URL
[3]	Siripassorn K, Ruxrungtham K, Manosuthi W . Successful drug desensitization in patients with delayed-type allergic reactions to anti-tuberculosis drugs. Int J Infect Dis, 2018,68:61-68. doi: 10.1016/j.ijid.2018.01.006 URL pmid: 29410254
[4]	Tsuyuguchi K, Wada M . Management of adverse effects with antituberculosis chemotherapy. Kekkaku, 2011,86(2):87-99. URL pmid: 21404653
[5]	Adam J, Pichler WJ, Yerly D . Delayed drug hypersensitivity: models of T-cellstimulation. Br J Clin Pharmacol, 2011,71(5):701-707. doi: 10.1111/j.1365-2125.2010.03764.x URL pmid: 3093075
[6]	Takahashi R, Kano Y, Yamazaki Y , et al. Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. J Immunol, 2009,182(12):8071-8079. doi: 10.4049/jimmunol.0804002 URL pmid: 19494333
[7]	Yerly D, Pompeu YA, Schutte RJ , et al.Structural Elements Recognized by Abacavir-Induced T Cells.Int J Mol Sci, 2017, 18(7). pii: E1464. doi: 10.3390/ijms18071464 URL pmid: 28686208
[8]	Sang-Heon K, Young-Koo J, Jae-Hyung L , et al. ABCC2Haplotype is Associated With Antituberculosis Drug-Induced Maculopapular Eruption. Allergy Asthma Immunol Res, 2012,4(6):362-366. doi: 10.4168/aair.2012.4.6.362 URL pmid: 23115734
[9]	Vaghela JH, Nimbark V, Barvaliya M , et al. Antituberculosis Drug-Induced Fixed Drug Eruption: A Case Report. Drug Saf Case Rep, 2018,5(1):23. doi: 10.1007/s40800-018-0086-z URL
[10]	Bondalapati S, Dharma RV, Rampure D . Isoniazid Induced Cutaneous Leukocytoclastic Vasculitis in Extra Pulmonary Tuberculosis (Pott’s Spine): A Case Report. J Clin Diagn Res, 2014,8(8):3-5. doi: 10.7860/JCDR/2014/9000.4688 URL pmid: 25302231
[11]	Ladhari C, Fathallah N, Mokni S , et al. Lichenoid drug eruption associated with rifampicin. Presse Med, 2018,47(3):281-282. doi: 10.1016/j.lpm.2018.01.007 URL
[12]	Manchanda Y, Das S, Sarda A , et al. Controversies in the Management of Cutaneous Adverse Drug Reactions. Indian J Dermatol, 2018,63(2):125-130.
[13]	Lehloenya RJ, Dheda K . Cutaneous adverse drug reactions to anti-tuberculosis drugs: state of the art and into the future. Expert Rev Anti Infect Ther, 2012,10(4):475-486. doi: 10.1586/eri.12.13 URL pmid: 22512756
[14]	Bigby MD . Rates of cutaneous reactions to drugs. Arch Dermatol, 2001,137(6):765-770. doi: 10.1046/j.1468-3083.2000.00167.x URL pmid: 11405768
[15]	Eremy A, Schneider, Philip R . Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Concise Review with a Comprehensive Summary of Therapeutic Interventions Emphasizing Supportive Measures. Adv Ther, 2017,34(6):1235-1244. doi: 10.1007/s12325-017-0530-y URL pmid: 28439852
[16]	Paulmann M, Mockenhaupt M . Severe drug-induced skin reactions: clinical features, diagnosis, etiology, and therapy. J Dtsch Dermatol Ges, 2015,13(7):625-645. doi: 10.1111/ddg.12747 URL pmid: 26110722
[17]	Kano Y, Tohyama M, Aihara M , et al. Sequelae in 145 patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: survey conducted by the Asian Research Committee on Severe Cutaneous Adverse Reactions (ASCAR). J Dermatol, 2015,42(3):276-282. doi: 10.1111/1346-8138.12770 URL pmid: 25623158145
[18]	Jung HY, Park S, Shin B , et al. Prevalence and Clinical Features of Drug Reactions With Eosinophilia and Systemic Symptoms Syndrome Caused by Antituberculosis Drugs: A Retrospective Cohort Study. Allergy Asthma Immunol Res, 2019,11(1):90-103. doi: 10.4168/aair.2019.11.1.90 URL
[19]	Allouchery M, Logerot S, Cottin J , et al. Antituberculosis Drug-Associated DRESS: A Case Series. J Allergy Clin Immunol Pract, 2018,6(4):1373-1380. doi: 10.1016/j.jaip.2017.11.021 URL pmid: 29274824
[20]	孙晨, 王华 . 药物激发试验在药物超敏反应诊断中的应用. 国际皮肤性病学杂志, 2016,42(4):230-232. doi: 10.3760/cma.j.issn.1673-4173.2016.04.009 URL
[21]	Kasumagic-Halilovic E, Ovcina-Kurtovic N . Analysis of Epicutaneous Patch Test Results in Patients with Contact Dermatitis. Med Arch, 2018,72(4):276-279. doi: 10.5455/medarh. URL
[22]	Lee AY, Jung SY . Two patients with isoniazid-induced photosensitive lichenoid eruptions confirmed by photopatch test. Photodermatol Photoimmunol Photomed, 1998,14(2):77-78. doi: 10.1111/j.1600-0781.1998.tb00017.x URL pmid: 9638730
[23]	Shebe K, Ngwanya MR, Gantsho N , et al. Severe recurrence of drug rash with eosinophilia and systemic symptoms syndrome secondary to rifampicin patch testing in a human immunodeficiency virus-infected man. Contact Dermatitis, 2014,70(2):125-127. doi: 10.1111/cod.12155 URL pmid: 24450829
[24]	Lehloenya RJ, Todd G, Wallace J , et al. Diagnostic patch testing following tuberculosis-associated cutaneous adverse drug reactions induces systemic reactions in HIV-infected persons. Br J Dermatol, 2016,175(1):150-156. doi: 10.1111/bjd.14492 URL pmid: 26918554
[25]	雷建平 . 抗结核药物超敏反应实验室诊断方法研究进展及期望. 中国防痨杂志, 2015,37(9):923-927. doi: 10.3969/j.issn.1000-6621.2015.05.002 URL
[26]	孙勤, 沙巍, 桂徐蔚 , 等. 药物淋巴细胞刺激试验对于诊断抗结核药物所致超敏反应的价值及意义. 中国防痨杂志, 2014,36(12):1062-1066. doi: 10.3969/j.issn.1000-6621.2014.12.012 URL
[27]	Kobashi Y, Okimoto N, Matsushima T , et al. Desensitization therapy for allergic reactions of antituberculous drugs-evaluation of desensitization therapy according to the guideline of the Japanese Society for Tuberculosis. Kekkaku, 2000,75(12):699-704. URL pmid: 11201137
[28]	Kobashi Y, Abe T, Shigeto E , et al. Desensitization therapy for allergic reactions to antituberculous drugs. Intern Med, 2010,49(21):2297-2301. doi: 10.2169/internalmedicine.49.3590 URL pmid: 21048363
[29]	Chihara Y, Takahashi KI, Sakai N , et al. Successful desensitization therapy for a patient with isoniazid-induced hypersensitivity pneumonia. Respir Med Case Rep, 2016,18:78-80. doi: 10.1016/j.rmcr.2016.05.003 URL
[30]	Siripassorn K, Ruxrungtham K, Manosuthi W . Successful drug desensitization in patients with delayed-type allergic reactions to anti-tuberculosis drugs. Int J Infect Dis, 2018,68:61-68. doi: 10.1016/j.ijid.2018.01.006 URL pmid: 29410254
[31]	Collado-Chagoya R, Hernández-Romero J, Eliosa-Alvarado GA , et al. Tolerance Induction to Antituberculosis Drugs in a Patient With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap. Allergy Rhinol (Providence), 2018,9:2152656718783618. doi: 10.1177/2152656718783618 URL
[32]	Pech O, May A, Henrich R , et al. Oral rapid desensitization with rifampicin. Dtsch Med Wochenschr, 2001,126(1-2):16. doi: 10.1055/s-2001-9885 URL
[33]	Holland CL, Malasky C, Ogunkoya A , et al. Rapid oral desensitization to isoniazid and rifampin. Chest, 1990,98(6):1518-1519. doi: 10.1016/0091-6749(88)90448-4 URL pmid: 2245698
[34]	张玉兰 . 利福平、异烟肼过敏性皮炎脱敏疗法21例报告. 中国防痨杂志, 2000,22(4):240. doi: 10.3969/j.issn.1000-6621.2000.04.031 URL
[35]	Thong BY, Chia FL, Tan SC , et al. A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy. Asia Pac Allergy, 2014,4(3):156-163. doi: 10.5415/apallergy.2014.4.3.156 URL pmid: 4116042

时间(d)	时间点	利福平(mg)	配置液
1	9:00am	0.0003(1ml配置液)	300mg溶解于1000000ml水中
	6:00pm	0.0009(3ml配置液)	300mg溶解于1000000ml水中
2	9:00am	0.003(1ml配置液)	300mg溶解于100000ml水中
	6:00pm	0.009(3ml配置液)	300mg溶解于100000ml水中
3	9:00am	0.03(1ml配置液)	300mg溶解于10000ml水中
	6:00pm	0.09(3ml配置液)	300mg溶解于10000ml水中
4	9:00am	0.3(1ml配置液)	300mg溶解于1000ml水中
	6:00pm	0.9(3ml配置液)	300mg溶解于1000ml水中
5	9:00am	3(1ml配置液)	300mg溶解于100ml水中
	6:00pm	6(3ml配置液)	300mg溶解于100ml水中
6	9:00am	12(4ml配置液)	300mg溶解于100ml水中
	6:00pm	24(8ml配置液)	300mg溶解于100ml水中
7	9:00am	30(1ml配置液)	300mg溶解于10ml水中
	6:00pm	60(2ml配置液)	300mg溶解于10ml水中
8	9:00am	90(3ml配置液)	300mg溶解于10ml水中
	6:00pm	120(4ml配置液)	300mg溶解于10ml水中
9	9:00am	150(5ml配置液)	300mg溶解于10ml水中
	6:00pm	180(6ml配置液)	300mg溶解于10ml水中
10	9:00am	210(7ml配置液)	300mg溶解于10ml水中
	6:00pm	240(8ml配置液)	300mg溶解于10ml水中
11	9:00am	240(8ml配置液)	300mg溶解于10ml水中
	6:00pm	240(8ml配置液)	300mg溶解于10ml水中
12~13	9:00am	300	300mg/片
14	9:00am	450	450mg/片