DRUG-INDUCED DISEASES IN KHARKOV REGION OF UKRAINE

E.N.Soloshenko

The Ukrainian Scientific & Research Institute of Dermatology & Venerology, 7/9, Chernishevskogo str., Kharkov, 61057, Ukraine,

Fax: (0572) 475508, e-mail: apb@venera.kharkov.ua

Drug-induced disease ( DID ), Morbus medicamentosus, is a multifactor disease when all the systems of organism are involved into pathological process with one of them being primarily affected. It usually runs in persons with constitutional and genetic predisposition against the backgrounds of the basic disease treatment as well as the latent sensibilization caused by immune system peculiarities rather than pharmacological properties of medicinal remedies themselves. According to the data obtained by different authors, occurrence of drug-induced disease ranges widely from 5 to 60 per cent, averaging between 10% and 15%. Its true incidence in Ukraine is still unknown.

Taking the above-mentioned into account, the scientists of the Ukrainian Scientific & Research Institute of Dermatology & Venerology ( USRIDV ) have examined some isolated groups of population in Kharkov and Kharkov region which can be identified as the running-risk groups. For example, among 105 workers of TURBOATOM and 465 employees engaged in pharmaceutical business, the clinical and laboratory investigations have revealed DID in 47.6% and 32.9% of the persons examined, respectively. Dependence of sensibilization on the state of adaptation - compensatory mechanisms, immune homeostasis, age, blood group, somatic type, neuroticism level, etc. has been noted.

Analysis of the number of patients suffering from DID and seeking help at the consultative out-patient department has revealed constant annual tendency to its increase, amounting up to 35 persons per 1000, though this characteristic cannot be considered to reflect the real prevalence of the disease. This conclusion has been confirmed by the number of allergic and toxic reactions to drugs registered by Kharkov emergency aid service and local and regional allergological centers. In recent years,more and more increasing number of DIDs is seen in the patients with disseminated dermatoses that makes study of this aspect one of the "hottest" areas in current dermatological researches. According to the USRIDV clinical data, drug-induced disease has been registered in 25.1% patients suffering from different dermatoses:

psoriasis - 8.2%,

eczema - 5.8%,

allergic and atopic dermatitis - 1.3%,

urticaria -1.2%,

mycosis and onychomycosis of feet and hands - 0.9%,

pyodermatites - 0.9%,

lupus erythematosis - 0.8%,

neurodermatitis - 0.7%,

reticulosis - 0.5%,

erythrodermia -0.4%,

pemphigus -0.3%,etc.

Among the persons examined during two years (1996-1998) DID was prevalent in women (73.67%) at the age from 20 to 50 (74%) though the age of all patients ranged from 14 to 69. The distribution of the above patients by their social status was as follows: employees (36.1%), pensioners (19.9%), housewives (15.2%), workers (14.6%), medicinal personnel (6.3%) and students (8.47%). Acute clinical indications of DID have been found in 59 patients suffering from DID (40.9%) and in 85 persons (59%) having DID in their past history. Acute clinical manifestations of DID have been observed, for the first time, in 40 % of persons and the remoteness of the manifestations was between some days and one year. In 19% of patients, the clinical manifestations have progressed as a recurrence of DID. The remoteness of DID in the persons having DID in their life history varied from 3 months up to 33 years. Both acute and latent forms are widespread among the patients with skin (54.2% and 75.3%, respectively) and somatic pathologies (45.8% and 24.7%, respectively) and manifest themselves in the course of their treatment. Analysis of the clinical picture of DID in all the patients of this group shows that in practice those DID manifestations are widely encountered which follow the pattern seen in urticaria and Quincke edema (54.1%), polymorphic exsudative erythema (9%) and anaphylactic shock (5.5%). Analysis of concomitant diseases evidences that gastrointestinal (42.4%), cardiovascular (36.1%), infectious (19.4%), nervous (19.7%), allergic (15%) and endocrine (11.1%) pathologies are more frequent in the patients with DID.

The most frequent causes of DID are penicillin (44.4%), other antibiotic preparations (31.9%), novocain (25%), lidocaine hydrochloride (21.5%), B-group vitamins (15.1%), antihistaminic preparations and corticosteroids (11%). Monosensibilization has been revealed only in 10.8% patients, sensibilization to 2 medicinal remedies - in 30.6% patients and to 3 and more remedies - in 48.2% patients examined. The patients developed the signs of DID onset after taking drugs orally (40%) or parenterally (48%) or by external usage (12%) though both single and daily doses were no more than the permissible ones. Along with polysensibilization to drugs, the patients with DID showed the polysensibilization to other allergens, namely, domestic (44.7%), food (42%) and pollen (22%) ones. Cold and actinic allergies have been registered in 19.9% and 30.6% patients, respectively.

Based on the above data, we can state with assurance that there is no full picture of DID incidence in Ukraine. The number of cases registered per year increases steadily but official statistical data can be considered just as "a peak of iceberg" because for the last few years various new preparations have appeared including corticosteroids and antihistamines which are the etiological causes of DID and have widespread application in different diseases therapy. The number of patients with polysensibilization ( to both medical preparations and other allergens) is also increases. Clinical DID manifestations suggest the tendency to growth of not only rare forms of skin diseases but severe generalized ones. Polymorphic forms of DID skin manifestations and their similarity with true dermatosis and pseudo-allergic reactions present some difficulties for its diagnosing. Thus, the allergological past history and clinical characteristics are often inadequate to make final clinical diagnosis of DID. So, the laboratory investigations have to be made safe for the patient health, characterizing his specific immunity and confirming the sensibilization to a particular medical preparation.