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Alergia a medicamentos
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Alergia a medicamentos

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DEFINICIÓN

La alergia a medicamentos es una reacción producida por la toma de un producto, que no responde a los efectos farmacológicos del mismo, que es impredecible y que se reproduce con pequeñas cantidades del mismo. Es una reacción adversa por medicamentos que se encuadra dentro de las mismas pero con características bien definidas y diferentes a otras reacciones adversas.

 REACCIONES ADVERSAS POR MEDICAMENTOS

A) PREDECIBLES: Relacionadas con la acción del fármaco y dependiente de su dosis.

Sobredosificación.
La administración de dosis altas de ciertos medicamentos producen alteraciones renales, hepáticas o intestinales.

Efectos colaterales.
Son los originados por acciones farmacológicas del medicamento no buscadas o deseadas, y su prototipo está representado por la somnolencia causada por los antihistamínicos H1.

Efectos secundarios.
Se hallan ligados a la acción farmacológica principal del medicamento, por ejemplo, el desarrollo gastritis por AINE (antiinflamatorios).

Interacciones farmacológicas

Efecto aditivo (Cimetidina y antihistamínicos alteraciones del ECG.)
Interacción fisicoquímica (inactivación por la mezcla en sueros)
Absorción gastrointestinal (interacción antiácidos y AINE)
Competencia por ligandos plasmáticos (clofibrato y cumarínicos)
Alteración del metabolismo (cimetidina y teofilinas)
Alteración de la excreción (bicarbonato y fenobarbital)
Teratotoxicidad, diversos fármacos en la gestación
B) NO PREDECIBLES: No relacionadas con la acción del fármaco, sino más bien de la respuesta del individuo.

Intolerancia. Parkinsonismo por ciertos antivertiginosos
Idiosincrasia. Efecto cualitativamente anómalo y sin base inmunológica (Asma por Aspirina)
Alergia. Efecto cualitativamente anómalo y con base inmunológica demostrable (anafilaxia por penicilina)
  TIPOS DE ALERGIAS A MEDICAMENTOS

En esta sección vamos a tratar de los cuadros más frecuentes de alergia a medicamentos, sabiendo que existen otras reacciones y no están descritas en el tema.

1. URTICARIA
La urticaria se caracteriza por erupción de ronchas o habones de tamaño y localización variables, con una evolución de 24-48 horas. En la mayor parte de los casos se asocia a un angioedema (edema angioneurótico o de Quincke), que en lugar de picor provoca sensación de peso o tensión, y deformación de la cara.

Medicamentos que producen urticaria alérgica:

ACTH. Acido acetilsalicílico. Aminoglucósidos. Amoxicilina. Anestésicos locales (del grupo PARA). Anovulatorios. Antidepresivos tricíclicos. Barbitúricos. Benzodiacepinas. Bleomicina. Calcitonina. Captopril. Carbamazepina. Cefalosporinas. Ciclofosfamida. Cis-platino. Clindamicina. Clonidina. Cloramfenicol. Contrastes yodados. Daunorrubicina. Dicumarínicos. Difenilhidantoína. Digital. Dipirona. Diuréticos mercuriales. Doxorrubicina. Ergotamina. Estreptodornasa. Estreptoquinasa. Etambutol. Etilclorovinol. Etosuximida. Etilendiamina. Fenotiazinas. Heparina. Hidrato de cloral. Indometacina. Insulina. Isoniazida. L-asparraginasa. Levamisol. Meprobamato. Metacualona. Metoclopramida. Metronidazol. Miconazol. Naproxén. Nitrofurantoína. Penicilinas. Pentazocina. Piperazina. Polimixina B. Procainamida. Procarbazina. Propiltiouracilo. Propranolol. Quinidina. Quinina. Ranitidina. Rifampicina. Sangre completa. Sueros. Sulfamidas. Tetraciclinas.Tiabendazol.Tiazidas. Tragacanto. TSH. Vacunas. Vancomicina.Vitamina B12.

2. ANAFILAXIA
Es una reacción general del organismo tras el contacto, aplicación o la toma de un medicamento, que aparece de forma inmediata ( 5-10 minutos) en forma de picor en las palmas de las manos y plantas de los pies, calor general, erupción en la piel con formación de habones, sensación de lengua gruesa y cierta dificultad para tragar, dificultad para respirar, tos, silbidos en el pecho y fatiga, taquicardia, vómitos, movimientos intestinales, ansiedad.
Si tras este cuadro persiste y no se trata aparecerá una coloración violácea de los labios y piel de las uñas, hipotensión y arritmia cardiaca, y entrada en shock, con perdida de conciencia y exitus.
La incidencia de anafilaxia (choque alérgico) es conocida en relación a la penicilina de 10 a 50 por cada 100.000 inyecciones, y de estas son reacciones fatales de 100 a 500 por año en USA.

Medicamentos que producen anafilaxia:

ACTH. Acido acetilsalicílico. Aminoglucósidos. Amoxicilina. Anestésicos locales (del grupo PARA). Anovulatorios. Antidepresivos tricíclicos. Barbitúricos. Benzodiacepinas. Bleomicina. Calcitonina. Captopril. Carbamazepina. Cefalosporinas. Ciclofosfamida. Cis-platino. Clindamicina. Clonidina. Cloramfenicol. Contrastes yodados. Daunorrubicina. Dicumarínicos. Difenilhidantoína. Digital. Dipirona. Diuréticos mercuriales. Doxorrubicina. Ergotamina. Estreptodornasa. Estreptoquinasa. Etambutol. Etilclorovinol. Etosuximida. Etilendiamina. Fenotiazinas. Heparina. Hidrato de cloral. Indometacina. Insulina. Isoniazida. L-asparraginasa. Levamisol. Meprobamato. Metacualona. Metoclopramida. Metronidazol. Miconazol. Naproxén. Nitrofurantoína. Penicilinas. Pentazocina. Piperazina. Polimixina B. Procainamida. Procarbazina. Propiltiouracilo. Propranolol. Quinidina. Quinina. Ranitidina. Rifampicina. Sangre completa. Sueros. Sulfamidas.Tetraciclinas.Tiabendazol.Tiazidas. Tragacanto. TSH. Vacunas. Vancomicina. Vitamina B12

3. EXANTEMAS VESICULO AMPOLLOSOS

3.1. ERITEMA MULTIFORME
Es una reacción cutánea con lesiones en su inicio son simples máculas o pápulas rosadas o eritematosas, a veces de aspecto urticarial; generalmente evolucionan en su región central adoptando a ese nivel un aspecto edematoso y por tanto, elevado, de tono oscuro violáceo e incluso aspecto ampolloso con persistencia del borde periférico eritematoso (lesiones en escarapela o diana).
Puede haber picor o sensación de quemazón asociados, y es característica de esta dermatosis su distribución lesional simétrica.
Las causas son diversas, a veces aparece como un síntoma de infección o activación de determinados microorganismos (herpes simple, Mycoplasma, bacterias) y otras son por mecanismos de alergia a medicamentos.

Medicamentos que producen eritema polimorfo o multiforme:

Alopurinol AINE. (antiinflamatorios no esteroideos): ácido acetilsalicílico, fenilbutazona, ibuprofén, meclofenamato, piroxicam, sulindac, zomepirac. Barbitúricos. Benzodiacepinas. Busulfán. Carbamazepina. Cefalosporinas. Cimetidina. Clindamicina. Cloroquina. Clorpropamida. Codeína. Difenilhidantoína. Eritromicina. Estreptomicina. Estrógenos. Etambutol. Etosuximida. Fenotiazinas. Fenolftaleína. Furosemida. Glutetimida. Griseofulvina. Hidralazina. Isoniazida. Ketoconazol. Mecloretamina. Metotrexato. Miconazol. Minoxidil. Mostazas nitrogenadas. Acido nalidíxico. D-penicilamina. Penicilinas. Prazosín. Propiltiouracilo. Propranolol. Quininas.

3.2. NECROLISIS EPIDERMICA TOXICA (SINDROME DE LYELL)
Es una reacción en forma de eritema generalizado, formación de grandes ampollas (como si fueran quemaduras) despegamiento epidérmico y una elevada mortalidad.

Los medicamentos que pueden producirla son:

sulfamidas
pirazolonas
hidantoínas
penicilina
Tuotromedico
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