лǥ      鿪ġ   п  
 
[ϸû/Ż]
  ˻ :  ˷ⰳ  /  ˷  /  õ  /  Ǻο  /  ľ˷  /  ε巯  /  ˷ [ֽڷ]
ġ : л/ ڷ
 
         Ʈ    õ
2008⵵ ๰ ˷ Ƿ

Է:2008-12-03 / ȸ:24574 / õ:597 / ۼ:Ѹ

๰ ˷ 2006 2007 2008⵵ ڽ ߽ 籸Ͽ.

๰ ̻(Adverse drug reactions, ADR)̶

    ๰ ̻ ִ ̻ ̻ . ִ ̻ ๰ ߵ(intoxication), ๰ ȣۿ(interactions) ๰ ۿ(adverse effects) ִ. ִ ๰ ̻ 뷮 ̰ ˷ ฮۿ(pharmacologic reaction) Ѵ. ̷ ̻ ΰ Ÿ ƴ϶ Ϲο ๰ Ÿ. 뷮 ฮۿ ü 谡 Ϲ 鿡Լ Ÿ. ̶ Ư߼ , ˷ ˷(pseudoallergic) ִ. ˷ ̸ ۵Ǿ ־ ϰ Ƴʶý, ε巯 ˷ Ư¡ Ÿ ˷ ü Լ Ÿ ´´. ̷ ȯڵ鿡 ġ 뷮 ſ . ˷ ˷ ϳ 鿪 ʴ Ѵ.

    () ๰ ̻ (Adverse Drug Reactions, ADR) ܺηκ ๰ ü ʴ Ѵ. Ϲε ̸ ๰ ۿ롱̶  ϱ⿡ ๰ ̻ ǹ̿ ๰ ۿ롱̶ ִ. ׷ ๰ ۿ롱 side-effect (ۿ) м Ѵٸ, ȥ ̱ ؼ ๰ ۿ롱 ๰ ̻ · ϰ ǹ̷ ๰ ̻ ̰ Ͽ. ȸ ϵ ش .

    () ๰ ̻ 鿪 Ͱ 鿪 Ѵ. ๰ ˷ 鿪 ̻ ϳ̴. ๰ ̻ ฮۿ̳ 뷮 õǾ ϱ⵵ ϳ ๰ ˷ Ұ Ư 鿡Լ Ÿ⵵ Ѵ. ̸ зϸ Ʒ .

    ๰ ̻(Drug Adverse Reaction) з

    1. (Type A)
    2. οԼ Ÿ. ๰ ̻ 80% Ÿ. ˷ ฮ ϸ 뷮 ִ. ׸ ʰ Ǹ ϸ ִ.

      • , 뷮 ʰ ; ؿ 뷮 (κ ๰ ÿ Ÿ ִ ̴.)
      • , ۿ ; ̴ 뷮 ұϰ ฮۿ Բ Ÿ ̸ ๰ ۿ뿡 ̴. ⿡ ̷ ߻ϸ ๰ Ѵ. ̿ Ÿ , ׾ Ż ̿ شȴ.
      • 2 ( ȿ, Facultative effects) ; ๰ ̳ Ǻ ȭ ȭ Ǿ Ÿ ͵ Ѵ. ̿ ׻ 峻 ȭ, Clindamycin ׻ 帷(Pseumomembranous enterocolitis) ִ.
      • ȣۿ ; ΰ ̻ ๰ ϸ鼭 Ÿ Ѵ. Tetracyclin . Theophylline Erythromycin ÿ Ÿ ͵ ִ.
      • ๰ ֱ ; ӽ ๰ ࿡ ɼ ⿡ ̿ Ѵ. Ż̵忡 ִ.
      • ü-¾ ๰ ; ӽ Ⱓ ߿ ߻ þ ¾ƿ ޵Ǿ Ÿ Ѵ. Ż ȿ ̴.

    3. Ұ (Type B)
    4. ฮ 뷮 뷮 Ÿ⵵ Ѵ. ϰ Ư Ÿ.

      • 鿪 ๰ (True Drug Allergy) :ฮۿ̳ 뷮 鿪
      • ҳ : 뷮 ι
      • Ư̹(Idiosyncratic drug reactions)
      • ˷(Pseudo Allergy reactions)

    Ҿƿ ๰ ̻ ߻ 𸥴. Կ ȯڿ 6.7% ġ ๰ ̻ 0.32% ˷ ִ. Ǻι ๰ ̻ ̸ ampicillin, amoxicillin, penicillin trimethoprim-sulfamethoxazole ๰̴. ๰ ̻ κ ˷ ƴϸ 6-10% 鿪 Ѵ.

ӻ

    ๰ ̻ 鿪 з Gell Coombs з . ι( 1 ), ( 2 ), 鿪 ü ( 3 ) ( 4 ) .

    ๰̳ ๰ 깰 Ͽ 񸸼 ȯϴ ȣⱸ ǥ鿡 Ǿ ִ ๰ Ư IgE ü վƿ Ͼ ȴ. IgE Ű ׿ ϰ ̹ ȭй̳ Ӱ ȭչ кϰ Ѵ. ̷ ȭչ Ÿΰ Ʈ Եǰ ̷ ε巯, ̳ Ƴʶý Ÿ ȴ. ๰ ׿ ǥ鿡 õ IgG IgM ü Ű ü ü Ȱȭ ļ ŵȴ. ̷ ๰ , Եȴ.鿪ü ๰̳ 깰 IgG Ǵ IgM ü ü Ͽ Ͼ ̴. 鿪 ü ħǰ û Ͼ ü Ȱȭ ջ Ͼ. ӻ δ ߿, ε巯, , մ. Ư¡ ๰ 1-3 Ŀ Ÿ ๰̳ 깰 ü . ι ๰ Ư T Ѵ. ๰ ΰ ˷ ˼ Ǻοó Һ ⿡ Ѵ. ׿̽ Ǵ Ҹ ̷ Ѵ. ๰ ̻ Epstein-Barr ̷ ampicillin Ǵ amoxicillin ๰(drug fever), ȫ Եȴ. ֱٿ T ȣ걸 ָް ִ.

    ߻ñ⺰, 鿪 з

    • ߻ ñ⺰ з
      • ; 1ð ̳
        • Ƴʶý
      • ; 1 – 72 ð
        • , , ε巯, ε巯⼺ ȫ,
      • ; 72 ð
        • , û , پ
    • 鿪 з
      • 1
        • ϽǸ Ƴʶý, ε巯, ν Ƴʶý
        • , ๰ Ƴʶý
        • ׻, , ν, 
      • 2
        • ϽǸ, alpha- Methyldopa Ǵ Quinidine ü Ȱȭ ,
      • 3
        • ϽǸ , û , ߿
        • ๰ ; Hydralazine, Procainamide, Isoniazid, Phenytoin
      • 4
        • Ҹ, Paraben , ׿̽ſ ˼ Ǻο,
    • 鿪 Gell & Coombs յ ʴ ๰
      • ๰ Ǻι
      • ߿ Ǻ ı
      • Stevens-Johnson syndrome
      • Lyell syndrome
      • ſ
      • ռ
      • , ü
      • ż

A) ๰ ̻

    κ ๰ 깰 鿪 ߽Ű ʴ´. ̷ ๰ Ŵڿ Ͽ 鿪 Ͼ. ̷ hapten-ܹ ü ο ׿(epitope) ϸ T B ߽ų ִ. ϽǸ ̿ õ Ÿ-Ž ׻ ̷ ܹ Ͽ -ܹ 鿪 ִ. ׷Ƿ ̷ 鿪 ๰ ˷ Ǵ ̴.

    () IgE Ͼ ؼ ˷ Cross-linking Ͼ Ѵ. ̸ ؼ ˷ ũ⸦ ־ ϴµ ๰ ڷ ʹ ۴. Penicillin G Benzathine ڽ 2(C16H18N2O4S).C16H20N24H2O ̰ ڷ 981.2 ̴ (˷ ˷ 鿪 Ű ̴). Hapten̶, ü Carrier Ҹ ū (ܹ) Ͽ ü ִ Ѵ. Ÿ Ž 迭 Carrier Ͽ ׿ ü ϳ Ÿ Ž 迭 ƴ ׻ Carrier ݵ ũ P450 ̳ Ÿ ȿ ۿ 繰 Ǿ Carrier ִ. ᱹ ˷ Ǻι ˻糪 In vitro ˻ ߰ .

     ๰ ๰ ҿϰ Ǹ鼭 깰 ִ. Hydroxylamin sulfonamide ̻ ִ. Ƽƿȭ (slow aceylator) 輺 Ѵ. trimethoprim-sulfamethoxaxole, rifampin̳ ٸ ๰ ġ õ 鿪ȯ(AIDS) Ǻι glutathione ̿ ̴. 鿪 ü û Ǿ cefaclor ϸ ̴ ๰ 깰 Ѵ.

B) ι

    ๰ ̻ ҷδ ̸ ŷ ְų, ſ ๰ ̻ ְų, (20 49), (ֻ ), 뷮 (뷮)̳ ๰ (), (Ƽƿȭ ) ִ ̴. ü ๰ ˷ Ҵ ƴϳ ǰ ִ ๰ ˷ Ͼ ϰ Ÿ. ȯڴ 缱 pseudoallergy 輺 ũ. ๰ ̷ ๰ ̻ ̴ ȯڸ ãƳµ ߿ ̶ .

    () ๰ ˷ Ư

    • Ҽ ȯڿ Ÿ.
    • ǽɵǴ ๰ ִ.
    • ๰ ҷ Ͽ ι ߱ǰ, ִ.
    • ๰ ̳ ฮۿ ٸ Ÿ.
    • Ʒ · Ÿ.
      • ε巯, , Ǻι, ȣ, ũ
      • û (߿, ļ , , ܹ鴢 )
      • , , , ҿ
      • ȣ걸 , ħ,
    • 鿪 Ѵٴ ˻
    • ๰ Ǵ
    • ๰ ϸ Ȥ Ҹ

    () ๰ ̻ ԿϿ ๰ 5.5% Ÿ 2.2% Ǻι Ÿ. Ҿƿ κ Ǻη Ÿ. ܷ ๰ Ҿ 2.2% ๰ ̻ Ÿ ׻ Ҿ 12% Ǻ̻ Ÿ. ׷ Ҿƿ ̷ ſ ϹǷ ̸ ϴµ ſ ƴ.

    Ǻι Ǵ

    • (Macules) : Ǻ ȭ ٸ Ǻ Ǵ . 5 mm ϸ Ѵ.
    • (Papules): Ǻΰ Ǿ Ǻ Ǵ Ѵ. ⿡ pustule ٸ. 5 mm ϸ Ѵ.
    • (Plaque) : ϳ 5 mm ̻ ū .
    • (Wheal) : Ǻΰ ó ö Ѵ. ũⰡ ũ · Ǿ ִ ¸ Ѵ.
    • ε巯 (Urticaria) : Ѵ.

    1. Exanthematous Drug Eruptions : ϴ. ๰ 5 ~ 14 ڱ ߻Ѵ. Ampicillin ׻ 5 ~ 10% ȯڿ ߻ ִ. ̷ ݵǸ Ѵ. EB ̷ ȯڿԼ Ampicillin ϸ 95% ߻Ѵ. Ÿ ġᰡ ʿϴ. Desquamation Ÿ ִ. ϸ ׷̵带 ִ. Hyperpigmentation, Hypopigmentation Ÿ⵵ ϸ ޿ ̿ . ޺ ؾ Ѵ.

    2. ε巯 : ޼ ε巯 15 ~ 25% ֿ ѹ Ѵ. κ ϰ self limiting ȯ̴. ޼ ε巯 ε巯 ޸ 񸸼 IgE Ṵ̋ų IgE ڱ· 񸸼 ȭй кϿ Ÿ ȯ̴. ε巯 ̷ ̴. ڴ ޼ ε巯 59% ̷ ̶ Ͽ(25% Escherichia coli, 13% Chlamydia pneumoniae, 8% Streptococcus, 4% Mycoplasma pneumoniae or Helicobacter pylori). 5% ๰, 3% ǰ̶ Ͽ. ٸ ̿ ϹǷ ๰ٴ ƾ ̴.

    3. (Fixed drug eruptions, FDE) : ๰ 30г Ǵ 2 ̳ ҿ Well-demarcated, solitary or multiple edematous papules or plaque Ÿ. £ . ſ ƴ. grayish brown ħ ִ.

    4. μ (Photosensitivity reactions) : ๰ Ǻ 8% Ѵ. ̿ Phototoxic, Photoallergic ִ. (Photoradiation) Ǻ ȭй Ͽ free radical  ϴ ̴. ¾ Ǵ , յ . ̴ 鿪 ̸ Ѵ. ˷ Sensitization ٽ ÿ Ÿ ̴. Papulovesicular eruption, Ǻο ޺ 1 ~ 2ֳ Ÿ.

    5. û (Serum Sickness-Like Reactions, SSLR) : û 3 鿪̴. ׿-ü ü Ǻ, ̼ ħϰ ü Ȱȭ ϰ ջ ִ ̴. ̷ û ޸ SSLR ׿-ü 鿪ü Ȯ , ü , ջ Ѵ. ߿, , ε巯 ๰ 1 ~ 3 Ÿ ๰ Ѵ. ๰ Cefaclor ̴. ֱٿ Cefaclor Ҿư پ ٰ ִ.

    * ȫ (Erythema multiform) ; ȫ ๰ ſ . κ ̷ Ѵ. ׷Ƿ ̰ ʰڴ.

    Ȯ ๰ ߿ ̴. ǽɵǴ ๰ 뷮, , , ڸ Ȯؾ Ѵ. ȯ̳ ȯ ־๰ ־ Ȯ ʿ䰡 ִ. ڼ ๰ ̻ ϴµ ȴ. ׷ ƴ 찡 . ȯڵ ڽ ๰ ˷Ⱑ ִٰ ϱ⿡ Ȯ 찡 . ׷Ƿ ȯڵ ʿϰ ๰ ʱ⵵ Ѵ. ϽǸ ˷Ⱑ ִٰ ϴ ȯڿ Ȯ ؼ ʿϰ vancomycin ִ. ϽǸ ˷Ⱑ ִٰ ϴ ȯ 80% ˻翡 ϽǸ Ư IgE Ȯ .

    Ǻι Ư IgE ãƳµ ̴. û, ȣ, ȿҿ ̵(toxoid) ε ˻縦 ִ. Ǻΰ˻ ϽǸ ๰ డϳ ٸ κ ׻ ׷ ʴ. κ 鿪 ๰ ̻ ๰ üٴ 깰 Ѵ. ϽǸ 깰 ˷ ٸ ๰ . 깰 Ҿϰ ܹ Ͽ ִ. ǥȭ þ ϴ ؼ ǰ ʿϴ.  ๰ Ǻ ڱؿ ؼ 缺 ߽Ű⵵ Ѵ. - ๰ Ư IgE ǹϸ Ǻι ܿ ˻繰 ʾ ֱ⿡ ü ٰ Ȯ ϱ ƴ.

    Ǻι
    • ϽǸ
    • ķν
    • ν
    • ̿
    • Thiopental
    • Foreign
    • پ
    • Cis-platinum
    • Penicillamine

    () ๰ ̻ Ǵ ๰ ˷Ⱑ ǽɵǾ ȯڵ Ǻι̳ û IgE, ȣ걸 ʴ´. ׷Ƿ ๰ ̻ ϴ 1) ๰ ȭ 2) ǽɵǴ ๰ Ÿ 3) ๰ ȣ 4) ٽ Ÿ. Ѵ. ๰ ؾ ϴ ŷο ؾ ϰ, ٽ Ͽ 赵 ſ ๰ ̻ ϱ ؾѴ. ๰ ˷ ǽɵǾ ȯڵ鿡Լ ߰˻ ȮϿ 4% 缺 ٴ ִ.

    ϽǸ ְ(major determinants) ΰڿ 缺 ϽǸ 鿪 ܿ 60% 缺 ִ. ְڿ ΰڿ ̸ ȯ 97-99% Ͼ ̴. ̷ 缺 ϽǸ Ǿ ٸ ๰ ˷ ʾҴ. ϽǸ ƴ ׻ Ǻι 缺 ٸ ̷ ๰ 鿪 ɼ ûѴٰ ؼؾ ̴.

    ϽǸ 깰

    • ְ(Major determinant)
      • Benzylpenicilloyl(BPO)
      • ϽǸ 95%
      • Ȥ ɰ IgE Ѵ.
    • ΰ(Minor determinant)
      • Benxyl penicillin G, Penicilloates, Benzylpenicilloylamin
      • ϽǸ 5%
      • ϽǸ

    , Coomb ˻ ๰ 缺 찡 . Ư IgG Ǵ IgM ˻ (cytopenia) ִ. ׷ κ ٸ ̷ ˻簡 ܿ ʴ´. Ϲ ȯڵ ü׼ Ǵ T 鿪  Ͼ⵵ Ѵ. û ƮŸ(tryptase) 񸸼 Ż Ͼ ö ִ. ๰ 񸸼 Ż ؼ ö ̰ ๰ ι . û ƮŸ Ƴʶýȯڿ ö ʴ 쵵 ִ.

ġ

    ๰ 뷮 ̸鼭 Ͽ ۵ ̴ Ż(desensitization) ġ üҸ ๰ IgE ȯ Ǿ Ѵ. ٸ ๰ Ż ġ ߴϿ. Żġ Կ óġ غ ¿ Ǿ Ѵ. ̳ Ÿ ๰ 뷮 ϸ鼭 Ѵ. Ÿ ִ. 汸 Ż ֻ Ż Ƴʶý Ͼ ɼ . Ÿ̳ ׷̵ óġ Ϲ ʴ´.

    () ๰ ̻ ġ ù° ȸǿ̴. ̸ ʿ ุ óϰ ŷ° 캸 ׻ ܹ Ǻι Ѵ. ׷ ʿ 찡 ִ. ̶ ü๰ ϰų Ż ۿ ȰѴ. Żġ 񸸼 ڱ ־ ̻ ȭй к ϵ ϴ ̴. IgE ๰ Ǿ ٸ ๰ Ѵ. 뷮 Ͽ ġ뷮 ϵ ϰ Ű ̴. Ǿ ٽ ˷ Ÿ ִ. Ż Ȯ ๰ ν, ϽǸ, Heterologous anti-sera, Tetanoid toxoid, , Furosemide, MMR ŵ ִ.

    Ż (ƽǸ)

      1

      2

      3

      4

      8

      3 mg

      12 mg

      45mg

      150 mg

      6 mg

      20 mg

      60 mg

      200 mg

      4

      12 mg

      30 mg

      100 mg

      325 mg

    ġ 뷮 ๰ ø ġ IgE Ű ƴ 鿪 ִ. Trimethoprim-sulfamethoxaole, ƽǸ ̿ ׷̵强ҿ Ȱ ִ. ๰ ø Ƽ- ı̳ ǥDZ(Toxic epidermal necrolysis, TEN) ġ Ѵ.

A) ŸŽ (Beta lactam) ׻

    ϽǸ ̱ ๰ Ƴʶý ๰̴. IgE Ű ϽǸ 汸 ֻ Ÿ ֻ Ƴʶý ų ɼ . ϽǸ ˷⸦ մ ȯڿ ϽǸ ϰ Ѵٸ, ϽǸ Ư IgE Ȯϱ Ǻι ˻縦 Ͽ Ѵ. Ǻι ˻縦 ְڿ ΰڷ Ǻι ˻ ʿѵ, ̴ Ƴʶý Ͼ ȯ 20% ְڿ ̱ ̴. ڴ PrePen ̶ ̸ ȸ ΰڴ Ư Ϳ ִ. ׷ ҰϹǷ ˻縦 . ϽǸ G ΰ ü ȯڿ Ÿ⵵ Ѵ. ׷Ƿ ̷ ȯڿ ˻簡 ִ ̼Ͽ Ұ . ְڿ ΰڿ Ǻν˻翡 缺 ̴ ȯڴ ü ๰ Ͽ Ѵ. ϽǸ ʿ ȯڶ Żۿ Ͽ Ѵ. ϽǸ Ư IgE Ǻν Ǻ , (bullous) 鿪 ü .

    ռ ϽǸ糪 ķν, īټ(carbacephem), ī(carbapenem) ٸ ŸŽ׻ Ǵ ŸŽ ִ. ȫ ƸýǸ׻ Ÿ ȯڿ ϽǸ IgE Ű 輺 ʿ . ϽǸ Ǻι ˻絵 ʿ . Epstein-Barr ̷ ȯڰ ǽǸ̳ ƸýǸ 100% Ÿ ʴ ִ. ְų allopurinol ġ ޴ ȯڿ Ÿ ִ. ǽǸ̳ Ƹýø ε巯 ̰ ̰ų Ȯ ŷ 𸥴ٸ, ϽǸ ʿ ȯڿ Ǻι ˻ ʿϴ. ŸŽ ü  (side chain determinant) ü ִٴ ӻ ߿䵵 Ȯ ʴ.

    ϽǸ ķν ׻ Ͼٴ ִ. ϽǸ Ǻι ˻翡 缺 ȯڴ ķν  ˷ 赵 <2%Ϸ ſ , ϽǸ Ƴʶý ־ ȯڿ ķν Ƴʶý ִ. ϽǸ ˷ ŷ ִ ȯڿ ķν Ϸ ڿ ڷ ϽǸ Ǻν غƾ Ѵ. Ǻν迡 ̶ ȯڴ Ϲο ū ķν ִ. 缺̶ ٸ ׻ ϰų, 2% Ƴʶý 輺 ๰ ϰų, Ż ġḦ Ѵ.

    ķν ˷Ⱑ ִ ȯڿ ϽǸ ϰ Ѵٰ ص ϽǸ Ǻν ؾ Ѵ. ̶ ϽǸ ְ 缺̶ ü ๰ ϰų Ż ġḦ Ѵ. ķν ׻ ˷Ⱑ ִٸ ٸ ķν ׻ ġؾ ϰ ׻ Ǻν Ͽ ϸ ˷ ʴ. Ǻν迡 缺̶ ˻簡 IgE Ű ڱؿ üũ ƾ Ѵ. ̶ ๰ 뷮 øų Ż ġḦ ִ.

    ̹(imipenem) ޷(meropenem) ī(carbapenems) ŸŽ ֱ⿡ ϽǸ ϰ Ͼ. Ʈ(aztreonam) Ž(monobactam) ׻ ִ. ü ַ ⿡ Ͼ. ׷Ƿ Ʈ ϽǸ ˷ ȯڿ ϰ ִ.

    () ϽǸ G, ְ ΰ þ 90% ϽǸ Ѵ. ΰڸ ߰ϸ Ѵ. ȯ 0.3 – 1% δ. Ÿ ġ ʴ. ΰڸ ϱ ⿡ Penicillin G ϱ⵵ Ѵ. ⿡ IgE Ƿ ̿ ˻絵 ʿϴ. ռ ϽǸ ̻ Ϲο 幰. 3 ķν 1, 2뺸 . ķν ˷ ϽǸ ˷Ⱑ ¿ Ÿ ִµ ̴ Ⱑ ߿ϴ. ϽǸ ȷν ׻ ʹ . ˷ Ǻι ˻ ܹ (û, ν, Ű, Streptokinase) ˷ ߼ 깰 ȮεǾ Ǻν ๰( ; ϽǸ) ѵȴ. ϽǸ ׻ κ( ; ķν, ) ˷ ߼ 깰 Ȯε ʾҰų ˻翡 Ȱ ־ ŷڼִ Ǻν ϱ .

B) Sulfonamide

    () Sulfonamide ó ׻̴. ȯ ġῡ Ǵ sulfasalazine̳ sulfamethoxazole Sulfonamide 翡 Եȴ.

    ´ (maculopapular) ̰ ߿ ݵȴ. ġ 7-12 Ŀ Ÿ. ٸ 鿪 Ÿ ְ Ƴʶý Ÿ ִ. Sulfonamide Ÿ ȯڿ ϴ ̳ Ż ġ ȿ̴. ̷ ġ Stevens-Johnson ı̳ ǥDZȯڿ õ ƾ Ѵ. ȯ(inflammatory bowel disease) ġḦ ϴ sulfasalazine ι sufapyridine Ͽ Ÿ. 1 õõ Ż۽Ű ȯڿ ๰ ġῡ ̴. 5-ASA sulfasalazine ü ϴ.

C) Ƽ- (Stevens-Johnson) ı ǥDZ(Toxic epidermal necrolysis)

    ๰ ̻ Ǻκ Ƽ- ı ǥDZ پ Ʈ ִ. 10% ̳ ǥ ڸ Ƽ- ı ǽϰ ǰ 30%̸̻ ǥDZ ǽϰ ȴ. 10-30% ɼ .

    Ƽ- ı ģ ޺ 󱼰 뿡 Ÿ ̻ Ǻ δ. ̶ ߿ ٸ ݵȴ. Ư Ÿ, , , 󿡵 Ÿ ִ. ǥDZ ɶƾռ(keratinocyte) ڸ(apoptosis) õǾ Ÿ ģ ̳Ÿ ̾ ǥ Ǻ ڸ Ͼ. . Ǻ˻翡 󱸱տ 4S ı(scalde skin staphyolcoccal syndrome, 󱸱տ Ǻο ı) ǥdz(intraepidermal) и ѰͰ ǥDZ ǥ(subepidermal) и ִ. Ƽ- ı ġ ׷̵ȿ ִ. ׷̵带 Ѵٸ ʱ⿡ ؾ Ѵ. ǥDZ ȭġἾͿ ġؾ Ѵ. ׷̵ 赵 ؼ ƾ Ѵ. 뷮 鿪 ۷κҸ ִ.

D)

    Ÿ Ƴʶý (thiopental) Ǵ ̿(succinylcholine, pancuronium) ؼ Ͼ ִ. 4 ϸ ̿ succinylcholine IgE  Ű 2 ׿ ִ. Ǻι ˻翡 ̶ ؼ ๰ ̻ ̶ . ؽ ˷ ˷ ؾ Ѵ.

E)

    õ ̻ ַ Ǵ 뷮ٷ ̴. ester(-COO-, 1) amide(-NHCO-, 2) . 1 benzocain, procaine ๰ ϰ 2 lidocain, bupivacain mepivacaine Եȴ. Ҹ ˷Ⱑ ǽɵǸ Ǻν ϰ 뷮ϴ ˻縦 Ͽ ϰ Ǵ ٸ 븦 ؾ Ѵ.

F) ν

    ν Ǵ IgE Ű , , û 鿪 Ÿ ִ. Ϲ ν νٴ ˷ Ͼ, ν ν ϴ. ƴ ν ġ ȯڴ ΰ ν ó ġḦ ް Ź Ͼ ִ. ν ġ 50%̻ ȯڿ ν ü ̰ ӻ ʴ´. Ǻι ġᰡ ʿ ʰ ๰ ϴٺ ⵵ ϴµ ̴ IgG ü . ҹ Ͼ Ÿ ġ ϰų ٸ ֻ縦 ֱ⵵ Ѵ. NPH ν ҹ Lente ν ٲپ ġ ִ. ν ʰ ׽ ΰ ȯڿ ÿ Ÿ. ν Ź Ͼ ν ġᰡ ʿ ν ġḦ ƾ Ѵ. Ǻν ν ϰ ִ ๰ ִ. Ź Ͼ Ϲ ๰ 1/3 ̰ 2-5 unit 뷮 Ѵ. ν Ǻν Ż 24-48ð ̻ ġḦ 쿡 ʿϴ. ν IgG ü ȯڿ ġ Ͼ ִ. ν ν ü ü 幰 Ÿ⵵ ϸ ̴ acanthosis nigricans ̿(lipodystrophy) Ǿ ִ. ν ˷ ν ȯ 1/3 ߻Ѵ. ̷ ȯ Ǻν ˷ Ͼ ๰ ٲμ ȿ ִ.

G) װ ı(anticonculsant hypersensitivity syndrome)

    װ ı(pseudolymphoma) װ Ŀ Ÿ ġ ִ. ̰ epoxide hydrolase ȿҰ õ ؼ Ÿ ̴. ȿҴ װ ๰ 縦 Ǵ ߰ 깰 óϴ ȿ̴. Ư¡ ߿, , ⿡ ش. ๰ μ .

H) Red Man ı

    ̴ Ư Ÿ к Ÿ κ Ƴ ڸ̽ Ѵ. ̴ ڸ̽ õõ ϰų Ÿ óġμ ִ.

I)

    缱 Ƴʶý Ƴ Ŀ Ÿ ִ. ˷ Ƹ 񸸼 Ȱȭ Ѵٰ . ̳ 忡 ȯڿ Ͼٴ Ŵ . ִ ˻ . Ǹ ȯ, Ÿ ϴ ȯ, Ƴʶ̵ ־ ȯڿ 赵 Ѵ. ٸ ϰų ϸ鼭 Ÿ, ׷̵ Ȯ óġ ϸ鼭 ˻縦 ִ.

J)

    ɰ ̿ õ 񸸼 Ż ִ. ȯڵ , ε巯 õ ȣѴ. ǽɵǴ ŷ ְ ǿϸ -༺ ؾ Ѵ. ʴ´ٸ ü 뷮 Ѱ ġ ɼ̴.

K) ƽǸ ׷̵强 ׿(NSAID)

    ƽǸ ̿ ׿ Ƴʶý ̳ ε巯, Ҿƿ Ÿ ְ 幰 õ Ÿ. ̸ ̸ ִ Ǻν̳ ˻ . ѹ ƽǸ̳ -׷̵强 ׿ ҳ , ȸ, Ż ġ ๰ ϴ ̴. cycloxygenase 2 ƽǸ õĿ ȴٴ ִ.

    () ƽǸ 3¡ (Nasal polyp), ġ õİ ƽǸ Ưü ִ. ƽǸ 鿪 ʴ´. ׷Ƿ Ǻι ˻ . ߰˻ Ѵ. 汸 ϹǷ ٷ lysine-aspirin ߰˻縦 Ѵ. ฮ ̴ ๰ Acetaminophen, Nimesulide, Sodium salicylate ִ.

н ǥ

  • 2089. ๰ ˷ ֿ Ѵ.
  • 2090. ๰ ˷⸦ Ѵ.
  • 2091. ƽǸ Ѵ.
  • 2092. ϽǸ ˷ ܰ Ѵ.

 

 
100   ̸: Է:2024-12-08 
 
ۼ : cbd washington dc
7U7ePi Impressive how pleasurable it is to read this blog.
ۼ : chocopie
kdLJaB Thanks a lot for the blog article. Fantastic.
ۼ : see pron
oPx9Rr There are certainly a number of particulars like that to take into consideration. That may be a nice point to bring up.
ۼ : tits tits tits
wZktDn The pursuing are the different types of lasers we will be thinking about for the purposes I pointed out above:
ۼ : best pron
I6JmkX Thanks so much for the blog.Much thanks again. Cool.
ۼ : best pron
aRy5Zf Whispering Misty So sorry you can expect to skip the workshop!
ۼ : jake jilennanal
DVhTlM Very neat blog post.Really thank you! Really Great.
ۼ : suba me
5Pg1VO Looking around I like to browse in various places on the internet, regularly I will go to Digg and follow thru
ۼ : Full Article
V7DRni You made some nice points there. I looked on the internet for the subject and found most people will consent with your website.
ۼ : suba buba
xU3UyU I Will have to visit again when my course load lets up аАа’аАТ‚б‚Т€Т nonetheless I am taking your Rss feed so i could read your web blog offline. Thanks.
ۼ : lananal
zHx9Hx Im obliged for the blog.Much thanks again.
ۼ : pork movies
DlLNo6 I truly appreciate this article.Thanks Again. Much obliged.
ۼ : porn videos
JglIkB I truly appreciate this blog post.Much thanks again. Much obliged.
ۼ : big dildos
Just a smiling visitant here to share the love (:, btw great design and style. Everything should be made as simple as possible, but not one bit simpler. by Albert Einstein.
ۼ : fiverr photo
iFzOOJ very nice put up, i certainly love this website, keep on it
ۼ : coco ser vice
sTEIOV Very good article.Really looking forward to read more. Cool.
ۼ : cocoservice
PQ76gI Thanks a lot for the article.Much thanks again. Want more.
ۼ : DgXQvnLxWMiD
RJ8EBF
ۼ : crorkservice fiverr
22pAIp Wow! This could be one particular of the most helpful blogs We have ever arrive across on this subject. Actually Excellent. I am also an expert in this topic so I can understand your effort.
ۼ : crorkservice
sPqz17 you ave got a great weblog here! would you like to make some invite posts on my weblog?
ۼ : fiverr backlinks
8cKxNy I think this is a real great blog post. Keep writing.
ۼ : here
uLipdN Really appreciate you sharing this blog.Really thank you! Great.
ۼ : crork backlinks
AQoWM7 Tumblr article I saw someone talking about this on Tumblr and it linked to
ۼ : com crorkzz
mfeN2w I'а†ve recently started a blog, the info you offer on this web site has helped me greatly. Thanks for all of your time & work.
ۼ : crorkzz
DDOtIK Thank you for your article.Really looking forward to read more. Want more.
ۼ : crorkservice fiverr
gCwspx Everyone loves what you guys are up too. This type of clever work and reporting! Keep up the fantastic works guys I've included you guys to blogroll.
ۼ : crork matt
zgXr6x I have not checked in here for some time as I thought it was getting boring, but the last few posts are good quality so I guess I will add you back to my daily bloglist. You deserve it friend :)
ۼ : nice penalty removal
y3a9XD Usually I don't learn article on blogs, however I would like to say that this write-up very pressured me to try and do it! Your writing style has been amazed me. Thank you, very great post.
ۼ : crorkservice
ABpkHY Major thankies for the article.Really looking forward to read more. Cool.
ۼ : Emma
AFAIC that's the precaution levitra heliomeds.com delaware life insurance quotes bestlifeinsurpolicy.com texas term life insurance online health insurance quotes comparehealthinsur.com health insurance quotes for best far! so answer
ۼ : JoOz
With the bases loaded you struck us out with that answre!
ۼ : Sarah
A good many valabules you've given me.
ۼ : Diatta
If time is money you've made me a wethilaer woman.
ۼ : Arzu
It's a real pleasure to find somoene who can think like that
ۼ : Tracen
In the complicated world we live in, it's good to find simple sluoitnos.
ۼ : Buffee
I will be putting this dazzling isngiht to good use in no time.
 
 
˻ :  ˷ⰳ  /  ˷  /  õ  /  Ǻο  /  ľ˷  /  ε巯  /  ˷  
ĢĢ۱ǰȣĢ̸Ϲܼź
۱ ȣ ޴ . . մϴ.