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对精神疾病药物过敏通常是错误诊断

来源:WebMD医学新闻 作者:Marlene Busko 2008-12-18
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摘要: 新研究显示,低于10%在药局纪录中被列为对精神病药物过敏的病患,实际上并没有过敏的问题,这项研究发现显示,药物治疗选择可能不需要因为错误的评断而受限。 Schleifer医师发现,79位被列在药局过敏纪录中,显示对治疗精神病药物过敏的病患,仅有7位有真正过敏的证据。他们发现这是可能的,但可信度并不高,另外12位病患......


  新研究显示,低于10%在药局纪录中被列为对精神病药物过敏的病患,实际上并没有过敏的问题,这项研究发现显示,药物治疗选择可能不需要因为错误的评断而受限。
  
  来自纽泽西州Morris Plains灰石公园精神科医院的Jeffrey R. Nurenberg医师与Stephen J. Schleifer医师发现,79位被列在药局过敏纪录中,显示对治疗精神病药物过敏的病患,仅有7位有真正过敏的证据。他们发现这是可能的,但可信度并不高,另外12位病患对这些药物有过敏反应。
  
  这项研究发现发表于美国精神科医学会第60届精神服务机构会议。
  
  对药物真正的抗原抗体反应可以造成严重且危及生命的问题;不幸的,有相当多过去有过敏史的病患,到最后却是毫无根据的,这可能增加接受效果比较不好或是价格较昂贵药物治疗的机会。
  
  【令人惊讶的 过敏的机率很高】
  一项于纽泽西州精神科医院的药局纪录分析显示,有相当多的病患对精神病用药与其他药物过敏;这引领了目前这项确认观察是否正确的研究。
  
  研究团队随机选择2006年1月某一天的病患记录,在那一天,585位住院病患中有301位(51.5%)至少对一种以上药物过敏。
  
  在585位病患中,138位(23.6%)对一种以上精神病药物过敏,包括haloperidol(11.1%)、chlorpromazine(6.0%)、fluphenazine(4.8%)与risperidone(4.1%)。
  
  被列为对精神疾病药物过敏的病患,51位不再回到医院,而8位拒绝或是无法参与这项研究。
  
  研究团队回顾病历摘要并访谈剩下的79位病患,看是否有过敏或是非过敏性不良药物反应的证据,这可能被误认为过敏。
  
  79位病患确实有过敏的比例比报告的数据低,这些病患中仅7位(8.9%)有对一种精神疾病药物过敏的确切证据,12位(15.2%)有可能但可信度不高的过敏反应,60位(75.9%)没有过敏证据。
  
  那7位对精神疾病用药真的有过敏的病患,其中1位罹患精神分裂症,另外6位罹患精神情感异常疾病;他们对于haloperidol(3位)、chlorpromazine(3位)、clozapine(2位)、risperidone(1位)、quetiapine(1位)药物过敏。
  
  【错误的过敏纪录局限了治疗选择】
  作者的结论是,这项研究数据支持了“精神疾病药物的过敏比例比药局与临床纪录的报告低很多”的假设。
  
  Nurenberg医师表示,对药物过敏会导致严重、潜在危及生命的状况,但许多病患错把不良药物反应当做过敏,接着这会变成医疗纪录的一部分,并随着他们被转介到新的健康照护者手上。
  
  病患可能因为这样的纪录而被处方新的、可能会有代谢相关不良反应的药物,而那些被错当为过敏反应元凶的药物却可能是安全且有效的。
  
  他表示,应该询问有关于过敏的详细临床病史,以取得对这些病患来说是安全且可能最有效的药物评估。
  
  这项研究由纽泽西州人类服务部门赞助。Nurenberg医师表示没有相关资金上的往来。

Allergy to Antipsychotics Often a False Diagnosis

By Marlene Busko
Medscape Medical News

New research shows that fewer than 10% of patients with pharmacy records listing an allergy to antipsychotics actually had a true allergy, a finding that suggests drug-treatment options might be needlessly limited by this false assessment.

Jeffrey R. Nurenberg, MD, and Stephen J. Schleifer, MD, from Greystone Park Psychiatric Hospital, in Morris Plains, New Jersey, found that of 79 patients listed in pharmacy records as having an allergy to an antipsychotic agent, only 7 had any evidence to support a true allergy. Further, they found it was possible, but unlikely, that 12 other patients had an allergy to these agents.

The findings were presented here at the American Psychiatric Association 60th Institute on Psychiatric Services.

"A genuine antigen-antibody response to a medicine can create a serious life-threatening problem. Unfortunately, an extraordinarily high number of people have a past history of 'allergy' that turns out to be unwarranted, and this may increase their likelihood of receiving treatment with less effective or more costly medications," he said.

Surprisingly High Rate of "Allergies"

A review of pharmacy records at a New Jersey state psychiatric hospital revealed a surprisingly high rate of allergy to antipsychotics and other psychotropic agents. This led to the current investigation to determine whether this observation was valid.

Investigators randomly selected patient records from a single day in January 2006. On that date, 301 of 585 inpatients (51.5%) were listed as having at least 1 allergy to a medication.

Of the 585 patients, 138 patients (23.6%) were listed as having allergies to 1 or more antipsychotic agents, including haloperidol (11.1%), chlorpromazine (6.0%), fluphenazine (4.8%), and risperidone (4.1%).

Of the patients listed as allergic to antipsychotics, 51 were no longer in hospital and 8 refused or were unable to participate in the study.

The investigators reviewed the clinical chart summaries and interviewed the 79 remaining patients to look for evidence of a true allergy or evidence of a nonallergic adverse drug reaction that might have been incorrectly diagnosed as an allergy.

True allergies among the 79 patients were much lower than the reported rates. A total of 7 (8.9%) patients had evidence of a true allergic reaction to an antipsychotic, 12 (15.2%) had weak evidence for a possible but unlikely allergic reaction, and 60 (75.9%) had no evidence of an allergic reaction.

The 7 patients with true allergies to antipsychotics were 1 patient with schizophrenia and 6 patients with schizoaffective disorder. They were allergic to haloperidol (3 patients), chlorpromazine (3 patients), clozapine (2 patients), risperidone (1 patient), and quetiapine (1 patient).

False Allergy Label Limits Treatment Options

The data support the hypothesis that true allergy to antipsychotics is much lower than reported rates reflected in clinical and pharmacy records, the authors conclude.

A true allergy to a medication can lead to a serious, potentially life-threatening condition, but many patients mistakenly think that any adverse reaction to a drug is an allergy, said Dr. Nurenberg. This then becomes part of their medical record and follows them whenever they are referred to a new healthcare provider.

Patients might be prescribed a newer agent with a risk for metabolic adverse effects when another agent that they were not truly allergic to might have been safe and effective.

It is important to take a careful clinical history about reported allergies to get an accurate assessment of medications that are safe and most likely to be effective in an individual patient, he said.

The study was funded by the State of New Jersey Department of Human Services. Dr. Nurenberg has disclosed no relevant financial relationships.

American Psychiatric Association 60th Institute on Psychiatric Services: Poster 37. Presented October 2, 2008.


 


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