Now, everyone knows that there is a dermatologist at Chang Gung Memorial Hospital who studies drug allergies. This dermatologist has a medical team composed of a group of passionate doctors. Text/?Photo provided by Wu Peifen/North Campus Chang Gung Memorial Hospital Drug Allergy Center started out as a group of interdisciplinary passionate doctors at Chang Gung Memorial Hospital. For the purpose of medical research, they came together from the bottom of their hearts to help patients and solve the problems that may occur after taking medications. All kinds of difficult and complicated diseases have appeared like this for 7 or 8 years. This group of doctors has accumulated a certain degree of tacit understanding. After Wang Zhengyi, the former director of Linkou Chang Gung Memorial Hospital, witnessed this situation, he said: "Let's just set up a center. "Let everyone know that Chang Gung Memorial Hospital has such a research team." Zhong Wenhong, the chief physician of the Dermatology Department of Chang Gung Memorial Hospital, who originally wanted to study the "Steven Johnson Syndrome" related to dermatology, and a group of like-minded doctors, came to the hospital under the supervision of the director. With the active promotion of Director Yang Zhixun of the Department of Dermatology, Taiwan's first "Drug Allergy Center" with clinical services as its mission was established. Zhong Wenhong was naturally recommended to serve as this cross-hospital and cross-department drug allergy center. director. From skin rashes and allergies caused by taking drugs to allergic shock caused by drug injections, as long as there is an allergic problem caused by drugs, everyone will think of Chang Gung Memorial Drug Allergy Center. Now, this interdisciplinary team takes the initiative to hold routine meetings every month to conduct interdisciplinary consultations and discussions on the patient's condition. Chang Gung Memorial Drug Allergy Center was established in January 2012. It is the first drug allergy medical team in China that is patient-centered and provides comprehensive care. The interdisciplinary team members include dermatology, neurology, gastroenterology, hepatobiliary, and thoracic medicine. , Department of Nephrology, Department of Infectious Medicine, Department of Plastic Surgery, Department of Ophthalmology, Department of Pathology, and Department of Pharmacy. There are three beds in the dermatology ward area, which are exclusive beds for patients with drug allergies. However, many patients' conditions are so serious that they are directly admitted to the intensive care unit as soon as they are admitted to the hospital. Zhong Wenhong said that the Drug Allergy Center has an exclusive laboratory. Similar professional laboratories only have such equipment and services in advanced countries such as Japan and Canada. The testing services provided by the laboratory include drug patch testing, in vitro allergy drug immune activation testing, and genetic testing. In the case of surgical shock, it may be caused by allergies to the drugs, muscle relaxants, or antibiotics used during the surgery. There may be more than 10 formulas of drugs used in one surgery. Which formula is it? Anaphylactic shock caused by a drug? This requires laboratory researchers and drug-specific antibodies and anaphylactic shock identification equipment in in vitro allergy drug immune activation tests to find out the drugs that cause allergies. Zhong Wenhong said that once an operation causes shock, the operation must be stopped and the allergens must be found. Otherwise, the patient's blood pressure will continue to drop and the patient's life signs may disappear at any time. The medical staff are also very anxious and do not know which one to stop. drug? One of his patients went into shock three times in a row before he found out the drug that caused his allergy. Gene testing is related to the discovery of many drug allergy genes in recent years. Zhong Wenhong's research topic when he was promoted from a resident physician to an attending physician focused on Stevens-Johnson & Johnson syndrome caused by epilepsy drugs. He said that Chang Gung Memorial Hospital receives 1 to 2 inpatients with Stevenson & Johnson syndrome every week. He read foreign literature and found that general hospitals abroad only receive 3 to 5 cases of severe drug allergy in a year. , many foreign medical personnel visited Chang Gung Memorial Hospital, which treated up to 50 patients with severe drug allergies a year. They were shocked when they saw such data. Zhong Wenhong began to actively collect patient information and delve into this issue. In 2004, Zhong Wenhong and the research team of Academia Sinica submitted a paper to the internationally renowned journal Nature. When the reviewers saw such a large number of patients, they suspected that the data was falsified. After verification, it was quickly published in April of the same year. . This is the first paper published in the journal Nature and published by a local research institute in Taiwan. It is also the first paper in the world to determine that drug allergy is related to genes. The content of the paper is "The anti-epileptic drug carbamazepine causes Stevenson-Johnson syndrome is strongly related to the human leukocyte antigen genotype HLA-B*1502 in the Han Chinese."
After the paper was published, some foreign experts in the same field, like the reviewers of Nature, initially questioned the local research in Taiwan. The European Severe Drug Allergy Research Alliance RegiSCAR (mostly composed of dermatologists, according to textbooks The definition of severe drug allergy (mostly from members of the alliance) therefore invited Zhong Wenhong to join the organization’s case registration system and requested to re-examine whether our cases meet foreign diagnostic standards. Zhong Wenhong must report to Europe as soon as he receives a patient Drug Allergy Alliance, and finally, the European Drug Allergy Alliance really believed in Zhong Wenhong’s research results. This paper has been cited more than 500 times so far. Zhong Wenhong said that after the paper was published, he had no time to think about pursuing a career in medical aesthetics. He was attracted by a series of drug research projects and patient consultations to the medical field of drug allergies. Even foreign medical research units actively approached him. Zhong Wenhong cooperated and gave speeches. In 2008, another research paper by Zhong Wenhong was published in the journal "Natural Medicine". The content was that it found that skin ulcers that cause severe drug allergic reactions are released when immune cells T cells are activated and then attack the skin. Lethal toxic proteins. Some people have studied all their lives and never had a chance to find the journal "Nature", but Zhong Wenhong published 2 papers in the journal "Nature" within 5 years. Will there be a third? Zhong Wenhong said with a smile: "It's a lot of pressure!" Now, everyone knows that there is a dermatologist at Chang Gung Memorial Hospital who studies drug allergies. This dermatologist has a medical team composed of a group of passionate doctors. Zhong Wenhong said that the number of patients in his drug allergy clinic has exploded, and each patient brings a pile of information and asks him to determine whether there is a drug allergy problem. Zhong Wenhong said that many patients are troubled by the side effects after taking medications and now come to him. His patient group is not limited to dermatology problems. Before some patients undergo surgery, they take a bunch of surgery information and ask the center to check whether they have any concerns about allergies before they dare to have surgery with confidence. Sometimes, Zhong Wenhong has to appear in court as a witness in a medical dispute case to prove The patient has a drug allergy; occasionally, the patient is voluntarily helped to fill out a drug injury statement and apply for drug injury relief. In the process of helping people, Zhong Wenhong also discovered the shortcomings of medical regulations. He said that drug hazard relief officials from Japan's Ministry of Health and Welfare went to Chang Gung Memorial Hospital for academic exchanges in February 2010. These officials said that the approval rate of Japan's drug hazard application cases is as high as 90%, which is higher than Taiwan’s 50%. When hearing cases, Japan’s Drug Harm Review Committee will focus on the patient’s perspective. When encountering gray areas in the trial conditions, they will consider passing relief. Zhong Wenhong said that most of the patients he encountered who were harmed by drugs belonged to relatively disadvantaged groups. In addition to facing the harm of their original diseases, these patients also had to endure the possible side effects of drugs, which was really hard. In Taiwan, when encountering medical disputes, most patients blame the medical staff. In European and American countries, pharmaceutical companies will be asked to compensate. This is a link that Taiwanese people pay less attention to when facing medical disputes. Now, Zhong Wenhong has been recruited to become one of the members of the Drug Injury Relief Committee of the Department of Health. Such a development was unexpected when Zhong Wenhong entered the Chang Gung Memorial Medical System. At first, I entered the dermatology department by chance, but I gave up on commercial aesthetic medicine and entered the unpopular field of drug allergy. I even had to deal with medical dispute cases. Zhong Wenhong said that he was often caught between patients and fellow doctors, which put him under a lot of pressure, and he could only handle it professionally. The first drug allergy patient meeting was held in April this year, with more than 70 participants. Many patients shared their experiences. At the end of the talk, some patients burst into tears. He sympathized with these patients. Zhong Wenhong pointed out that there are many drug-related relief groups formed by patients abroad, such as the Stevenson & Johnson Syndrome Foundation, and many of their members are lawyers. He also hopes that enthusiastic lawyers can stand up and help patients fight for their rights. . Team members / 24 interdisciplinary attending physicians 3 pharmacists 1 case manager 2 assistants This article is excerpted from issue 356