薬物特異体質反応

WordNet

(mechanics) the equal and opposite force that is produced when any force is applied to a body; "every action has an equal and opposite reaction"
a response that reveals a persons feelings or attitude; "he was pleased by the audiences reaction to his performance"; "John feared his mothers reaction when she saw the broken lamp"
a bodily process occurring due to the effect of some antecedent stimulus or agent; "a bad reaction to the medicine"; "his responses have slowed with age" (同)response
doing something in opposition to another way of doing it that you dont like; "his style of painting was a reaction against cubism"
an idea evoked by some experience; "his reaction to the news was to start planning what to do"
extreme conservatism in political or social matters; "the forces of reaction carried the election"
use recreational drugs (同)do drugs
administer a drug to; "They drugged the kidnapped tourist" (同)dose
a substance that is used as a medicine or narcotic
peculiar to the individual; "we all have our own idiosyncratic gestures"; "Michelangelos highly idiosyncratic style of painting"

PrepTutorEJDIC

{名}(…に対する)『反応』《+『to』+『名』》 / 〈U〉(…に対する)(政治的・社会的な)『反動』,逆コース《+『against』+『名』》 / 〈U〉〈C〉化学反応,化学変化 / 〈U〉〈C〉(物理学で)反作用
『薬』,薬品,薬剤 / 『麻薬』,麻酔剤 / 〈人〉‘に'薬(特に麻酔剤)を与える / 〈飲食物〉‘に'(麻酔薬・毒薬などの)薬を混ぜる

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/25 02:07:32」(JST)

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Idiosyncratic drug reactions, also known as type B reactions, are drug reactions that occur rarely and unpredictably amongst the population. This is not to be mistaken with idiopathic, which implies that the cause is not known. They frequently occur with exposure to new drugs, as they have not been fully tested and the full range of possible side-effects have not been discovered; they may also be listed as an adverse drug reaction with a drug, but are extremely rare.

Some patients have multiple-drug intolerance. Patients who have multiple idiopathic effects that are nonspecific are more likely to have anxiety and depression.^[1]

Idiosyncratic drug reactions appear to not be concentration dependent. A minimal amount of drug will cause an immune response, but it is suspected that at a low enough concentration, a drug will be less likely to initiate an immune response.

Mechanism

In adverse drug reactions involving overdoses, the toxic effect is simply an extension of the pharmacological effect (Type A adverse drug reactions). On the other hand, clinical symptoms of idiosyncratic drug reactions (Type B adverse drug reactions) are different from the pharmacological effect of the drug.

The proposed mechanism of most idiosyncratic drug reactions is immune-mediated toxicity. To create an immune response, a foreign molecule must be present that antibodies can bind to (i.e. the antigen) and cellular damage must exist. Very often, drugs will not be immunogenic because they are too small to induce immune response. However, a drug can cause an immune response if the drug binds a larger molecule. Some unaltered drugs, such as penicillin, will bind avidly to proteins. Others must be bioactivated into a toxic compound that will in turn bind to proteins. The second criterion of cellular damage can come either from a toxic drug/drug metabolite, or from an injury or infection. These will sensitize the immune system to the drug and cause a response. Idiosyncratic reactions fall conventionally under toxicology.

References

^ Davies SJ, Jackson PR, Ramsay LE, Ghahramani P (2003). "Drug intolerance due to nonspecific adverse effects related to psychiatric morbidity in hypertensive patients". Arch. Intern. Med. 163 (5): 592–600. doi:10.1001/archinte.163.5.592. PMID 12622606.

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UpToDate Contents

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1. 薬物アレルギー：分類および臨床的特徴 drug allergy classification and clinical features
2. 発疹性（麻疹様）薬疹 exanthematous morbilliform drug eruption
3. 自己免疫性溶血性貧血の病因：温暖凝集素と薬剤 pathogenesis of autoimmune hemolytic anemia warm agglutinins and drugs
4. 薬物アレルギー患者へのアプローチ an approach to the patient with drug allergy
5. 成人における溶血性貧血の診断へのアプローチ approach to the diagnosis of hemolytic anemia in the adult

English Journal

Drug-induced allergic hepatitis develops in mice when myeloid-derived suppressor cells are depleted prior to halothane treatment.

Chakraborty M1, Fullerton AM1, Semple K1, Chea LS1, Proctor WR1, Bourdi M1, Kleiner DE2, Zeng X1, Ryan PM1, Dagur PK3, Berkson JD1, Reilly TP4, Pohl LR1.
Hepatology (Baltimore, Md.).Hepatology.2015 Aug;62(2):546-57. doi: 10.1002/hep.27764. Epub 2015 Mar 25.
Clinical evidence suggests that many cases of serious idiosyncratic drug-induced liver injury are mediated by the adaptive immune system in response to hepatic drug-protein adducts, also referred to as "drug-induced allergic hepatitis"; but detailed mechanistic proof has remained elusive due to the
PMID 25712247

Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome or Hematologic Malignancy?: A Case Report of a 4-Year-Old Boy.

Besli GE1, Yldrm S, Ylmaz K, Yuksel E.
Pediatric emergency care.Pediatr Emerg Care.2015 Jul 20. [Epub ahead of print]
Drug reaction with eosinophilia and systemic symptom (DRESS) is a serious idiosyncratic drug reaction. It is characterized by skin eruption, fever, hematologic abnormalities, and multi-organ involvement. Diagnosis is challenging because of the wide clinical spectrum. Its association with aromatic an
PMID 26196365

Late-onset acetaminophen-induced allergic hepatitis with progression to chronicity.

Mishima-Iwai M1, Takahashi K1, Yokode M1, Kimura Y1, Sawai Y1, Ueda Y1, Chiba T1.
Hepatology research : the official journal of the Japan Society of Hepatology.Hepatol Res.2015 Jul;45(7):814-7. doi: 10.1111/hepr.12399. Epub 2014 Sep 2.
Acetaminophen (paracetamol), a widely used antipyretic/analgesic, is a well-known agent causing acute hepatic injury. Whereas most cases are caused by its intrinsic hepatotoxicity, idiosyncratic hepatitis by the allergic mechanism is extremely rare. We herein report a case of late-onset acetaminophe
PMID 25088083