The acute porphyria attack. 3. Acute porphyria: the precipitating and aggravating factors
Eales, L.
South African Medical Journal 1971: 120-125
1971
ISSN/ISBN: 0256-9574 PMID: 5150264 Document Number: 5841
This report, which is based on clinical experience, is particularly concerned with the drugs involved in the induction or potentiation of the acute attack of variegate porphyria (VP). Other relevant factors are also considered. During the period 1950-1970 145 attacks in 120 patients (107 with VP and 13 with AIP) have been studied. The drugs most commonly associated with the acute attack were the barbiturates, which featured in over 50% of the attacks, and in 20% a single barbiturate appeared to be the precipitating agent. The most frequently involved drugs were thiopentone and phenobarbitone, followed by quinal-, buto-, pento-, and amylobarbitone. In over onethird of the 'barbiturate-induced attacks' more than one barbiturate was implicated. The variable propensity of barbiturates to induce attacks is noted. A variety of 'non-barbiturate' hypnotics, unidentifiable soporifics, sulphonamides and a heterogeneous group of drugs featured as possible exciting factors of the acute attack. Included in this group are such structurally dissimilar substances as griseofulvin, dichloralphenazone, and the oral contraceptives. In vitro tissue culture techniques have also incriminated a wide variety of drugs. Other factors considered included infection, the abuse of alcohol, psychological stress, endogenous female sex hormone production, as well as exogenous chemical agents, organic and inorganic. The modifying influences are considered at length and the study of man rather than animal needs to be actively pursued. In an appreciable num ber of attacks no discernible p recipitating or aggravating factor was present. Such cases merit the closest study, not only of the gross composition of the diet, but also of possible contamination by porphyrogenic substances, whether chemical, bacterial, or fungal. The identification of a large number of hitherto unrecognized porphyrics during a family survey has resulted in a marked decline in the incidence of admissions to Groote Schuur Hospital. The recommended avoidance of the dangerous drugs appears to have had this beneficial effect.
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