作者：Marlene Busko
出處：WebMD醫學新聞
October 10, 2008（伊利諾州芝加哥）－ 新研究顯示，低於10%在藥局紀錄中被列為對精神病藥物過敏的病患，實際上並沒有過敏的問題，這項研究發現顯示，藥物治療選擇可能不需要因為錯誤的評斷而受限。
來自紐澤西州Morris Plains灰石公園精神科醫院的Jeffrey R. Nurenberg醫師與Stephen J. Schleifer醫師發現，79位被列在藥局過敏紀錄中，顯示對治療精神病藥物過敏的病患，僅有7位有真正過敏的證據。他們發現這是可能的，但可信度並不高，另外12位病患對這些藥物有過敏反應。
這項研究發現發表於美國精神科醫學會第60屆精神服務機構會議。
對藥物真正的抗原抗體反應可以造成嚴重且危及生命的問題；不幸的，有相當多過去有過敏史的病患，到最後卻是毫無根據的，這可能增加接受效果比較不好或是價格較昂貴藥物治療的機會。
【令人驚訝的 過敏的機率很高】
一項於紐澤西州精神科醫院的藥局紀錄分析顯示，有相當多的病患對精神病用藥與其他藥物過敏；這引領了目前這項確認觀察是否正確的研究。
研究團隊隨機選擇2006年1月某一天的病患記錄，在那一天，585位住院病患中有301位（51.5%）至少對一種以上藥物過敏。
在585位病患中，138位（23.6%）對一種以上精神病藥物過敏，包括haloperidol（11.1%）、chlorpromazine（6.0%）、fluphenazine（4.8%）與risperidone（4.1%）。
被列為對精神疾病藥物過敏的病患，51位不再回到醫院，而8位拒絕或是無法參與這項研究。
研究團隊回顧病歷摘要並訪談剩下的79位病患，看是否有過敏或是非過敏性不良藥物反應的證據，這可能被誤認為過敏。
79位病患確實有過敏的比例比報告的數據低，這些病患中僅7位（8.9%）有對一種精神疾病藥物過敏的確切證據，12位（15.2%）有可能但可信度不高的過敏反應，60位（75.9%）沒有過敏證據。
那7位對精神疾病用藥真的有過敏的病患，其中1位罹患精神分裂症，另外6位罹患精神情感異常疾病；他們對於haloperidol（3位）、chlorpromazine（3位）、clozapine（2位）、risperidone（1位）、quetiapine（1位）藥物過敏。
【錯誤的過敏紀錄侷限了治療選擇】
作者的結論是，這項研究數據支持了「精神疾病藥物的過敏比例比藥局與臨床紀錄的報告低很多」的假設。
Nurenberg醫師表示，對藥物過敏會導致嚴重、潛在危及生命的狀況，但許多病患錯把不良藥物反應當做過敏，接著這會變成醫療紀錄的一部分，並隨著他們被轉介到新的健康照護者手上。
病患可能因為這樣的紀錄而被處方新的、可能會有代謝相關不良反應的藥物，而那些被錯當為過敏反應元兇的藥物卻可能是安全且有效的。
他表示，應該詢問有關於過敏的詳細臨床病史，以取得對這些病患來說是安全且可能最有效的藥物評估。
這項研究由紐澤西州人類服務部門贊助。Nurenberg醫師表示沒有相關資金上的往來。
Allergy to Antipsychotics Often a False Diagnosis
By Marlene Busko
Medscape Medical News
October 10, 2008 (Chicago, Illinois) — 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.
[ 本帖最後由 goodcat1111 於 2008-10-20 23:20 編輯 ] |
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