Reacciones adversas cutáneas severas a medicamentos: estado del conocimiento

  • Ana M. Villa-Arango Grupo de Alergología Clínica y Experimental (GACE)
  • Ana M. Acevedo-Vásquez Grupo de Alergología Clínica y Experimental (GACE)
  • Ricardo Cardona-Villa Grupo de Alergología Clínica y Experimental (GACE)
Palabras clave: hipersensibilidad, hipersensibilidad a las drogas, efectos colaterales y reacciones adversas relacionados con medicamentos.

Resumen

Las reacciones adversas a medicamentos afectan de manera global entre el 10% y el 20% de los pacientes hospitalizados y el 7% de los pacientes ambulatorios. Aproximadamente, uno de cada mil pacientes hospitalizados sufren reacciones adversas que amenazan la vida. Las reacciones adversas a medicamentos, denominadas como reacciones alérgicas (inmunológicas), se pueden agrupar según la clasificación de Gell y Coombs en: tipo I (mediada por IgE), tipo II (citotóxica), tipo III (por inmunocomplejos) y tipo IV (hipersensibilidad retardada o celular). Actualmente, las reacciones tipo IV se subclasifican según la célula efectora involucrada y sus correspondientes citoquinas. Estos subgrupos se definen como: tipo IVa (con activación del perfil Th1, los macrófagos como células efectoras y liberación de INF-γ y TNF-α), tipo IVb (con activación del perfil Th2, los eosinófilos como células efectoras y liberación de citoquinas como la IL-5, la IL-4 y la IL-13), tipo IVc (con los linfocitos T citotóxicos como células efectoras y liberación de granzimas B y perforinas) y tipo IVd (con los neutrófilos como células efectoras y liberación de CXCL8 y factor estimulante de colonias de granulocitos y macrófagos). La presente revisión se centra en la epidemiología, etiología, fisiopatología y manifestaciones clínicas de las reacciones adversas cutáneas severas a medicamentos como el síndrome de Stevens Johnson, la necrólisis epidérmica tóxica, el síndrome DRESS y la pustulosis exantemática generalizada aguda (PEGA); además de un abordaje terapéutico en cada una de estas enfermedades.

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Biografía del autor/a

Ana M. Villa-Arango, Grupo de Alergología Clínica y Experimental (GACE)

Médica, residente en Alergología Clínica, Grupo de Alergología Clínica y Experimental (GACE). Medellín, Colombia.

Ana M. Acevedo-Vásquez, Grupo de Alergología Clínica y Experimental (GACE)

Médica, especialista en Alergología Clínica. Alergóloga clínica, IPS Universitaria, Universidad de Antioquia. Grupo de Alergología Clínica y Experimental (GACE). Medellín, Colombia.

Ricardo Cardona-Villa, Grupo de Alergología Clínica y Experimental (GACE)

Médico, especialista en Alergología Clínica, MSc en Inmunología. Docente titular, Universidad de Antioquia. Investigador senior, Director Grupo de Alergología Clínica y Experimental (GACE). Medellín, Colombia.

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Cómo citar
1.
Villa-Arango AM, Acevedo-Vásquez AM, Cardona-Villa R. Reacciones adversas cutáneas severas a medicamentos: estado del conocimiento. Med. Lab. [Internet]. 1 de noviembre de 2016 [citado 22 de abril de 2021];22(11-12):539-62. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/104
Publicado
2016-11-01
Sección
Monitoreo de drogas
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