The problem of hypersensitivity to vitamin preparations

S. Zaikov, G. Gumeniuk, L. Veselovsky
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Abstract

ABSTRACT. The problem of the development of adverse reactions as a result of the use of diagnostic and medicinal products (drugs) is becoming increasingly important. Patients more often report reactions to local anesthetics (43.2 % of cases), antibiotics (18.8 %), nonsteroidal anti-inflammatory drugs (9.7 %), other drugs (28.4 %), B vitamins (4-5 %). It is important to understand that hypersensitivity (HS) to vitamin preparations (VP) is very common, according to patients, but not so often confirmed by their in-depth allergy examination. Basic data on HS before the VP were obtained in the 80-90s of the 20th century, but since then the situation has changed radically. The frequency of HS on these drugs is based on medical history when patients use multicomponent VP for oral administration, allergens in which may be other components (shell tablets and capsules, metal salts, flavors, sweeteners, dyes, preservatives). The causative allergens in the injectable forms of VP can also be auxiliary ingredients of the drug, in particular lidocaine and benzyl alcohol. There are only a few scientific publications with the appropriate evidence base for HS to individual VP, more often B vitamins. The clinical picture of HS reactions to VP is diverse (systemic, cutaneous, respiratory, rarely other visceral manifestations). They can develop both immediately and in a delayed type. Part of the VP (B vitamins, vitamin K) can cause the development of anaphylaxis with fatal consequences. VP, as a rule, do not belong to vital drugs therefore it is possible for this reason till now in real clinical practice insufficiently developed methods of allergodiagnostics both in vivo (skin, provocative tests), and in vitro (laboratory tests) among patients with suspicion for the development of HS to VP. It is not possible to perform allergy diagnostics in persons who have taken complex VP, so there is a problem of hyperdiagnosis of drug allergy to them. Therefore, the problem of determining the true allergic reaction in patients who report the development of a history of HS to VP remains relevant. As a rule, after the development of any adverse reaction during the reception of VP on the patient hangs the label “allergy to vitamins” for life without further allergy examination. That is why the problem of HS to VP needs further study.
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对维生素制剂过敏的问题
摘要由于使用诊断和医药产品(药物)而产生不良反应的问题正变得越来越重要。患者更多地报告对局麻药(43.2%)、抗生素(18.8%)、非甾体类抗炎药(9.7%)、其他药物(28.4%)、B族维生素(4- 5%)的反应。重要的是要了解,根据患者的说法,对维生素制剂(VP)的超敏反应(HS)是非常常见的,但通过深入的过敏检查并不经常得到证实。在副总统之前的HS的基本数据是在20世纪80-90年代获得的,但自那以后情况发生了根本性的变化。这些药物发生HS的频率是基于患者口服多组分VP的病史,其中的过敏原可能是其他成分(壳片和胶囊、金属盐、香精、甜味剂、染料、防腐剂)。可注射形式的VP中的致病性过敏原也可以是药物的辅助成分,特别是利多卡因和苯甲醇。只有少数科学出版物提供了HS和VP的适当证据基础,更多的是B族维生素。HS对VP反应的临床表现是多种多样的(全身、皮肤、呼吸,很少有其他内脏表现)。它们可以立即发展,也可以延迟发展。部分VP (B族维生素,维生素K)可引起过敏性反应的发展和致命的后果。VP通常不属于重要药物,因此在实际临床实践中,可能由于这个原因,在怀疑HS发展为VP的患者中,体内(皮肤,刺激试验)和体外(实验室试验)的过敏诊断方法尚不充分。对服用复合VP的患者进行过敏诊断是不可能的,因此存在药物过敏超诊断的问题。因此,在报告HS到VP病史的患者中确定真实过敏反应的问题仍然是相关的。通常,在接受VP期间出现任何不良反应后,患者终身悬挂“维生素过敏”标签,无需进一步过敏检查。这就是HS到VP的问题需要进一步研究的原因。
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