Table 4

Clinical manifestations of drug allergy. [1,11,15]

Manifestation

Clinical Features

Examples of causative drugs


Skin

Exanthemata

• Diffuse, fine macules and papules

• Evolve over days post drug initiation

Allopurinol, penicillins, cephalosporins, anticonvulsants, sulfonamides


Urticaria, angioedema

• Onset within minutes to hours of drug administration

• Potential for anaphylaxis

• Often IgE-mediated

Antibiotics, ACE inhibitors, anticonvulsants, neuromuscular blocking agents, platinums, radiocontrast media, NSAIDs, narcotics


Fixed drug eruption

• Hyper-pigmented plaques that occur at the same site upon re-exposure to the culprit drug

Sulfonamide and tetracycline antibiotics, NSAIDs, ASA, sedatives, chemotherapeutic agents, anticonvulsants


SJS

• Fever, sore throat, fatigue, ocular involvement

• Ulcers and other lesions on mucous membranes, particularly of the mouth and lips, as well as on truncal area

Sulfonamides, nevirapine, corticosteroids, anticonvulsants, NSAIDs (oxicams), allopurinol, phenytoin, carbamazepine, lamotrigine, barbiturates, psychotropic agents, pantoprazole, tramadol


TEN

• Similar to SJS, but usually involves significant epidermal detachment

• Potentially life-threatening

Same as SJS


Hematologic

• Hemolytic anemia, leukopenia, thrombocytopenia

Penicillin, sulfonamides, anticonvulsants, cephalosporins, quinine, heparin, thiazides, gold salts


Hepatic

• Hepatitis, cholestatic jaundice

Sulfonamides, phenothiazines, carbamazepine, erythromycin, anti-tuberculosis agents, allopurinol, gold


Renal

• Interstitial nephritis, glomerulonephritis

Penicillin, sulfonamides, allopurinol, PPIs, ACE inhibitors, NSAIDs


Multi-organ reactions

Anaphylaxis

• Urticaria/angioedema, bronchospasm, gastrointestinal symptoms, hypotension

Antibiotics, neuromuscular blocking agents, anesthetics, radiocontrast media, recombinant proteins (e.g., omalizumab)


DRESS

• Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy

Anticonvulsants, sulfonamides, minocycline, allopurinol, strontium ranelate


Serum sickness

• Urticaria, arthralgias, fever

Heterologous antibodies, infliximab, allopurinol, thiazides, antibiotics (e.g., cefaclor) and bupropion


DILE

• Arthralgias, myalgias, fever, malaise

Hydralazine, procainamide, isoniazid, quinidine, minocycline, antibiotics, and anti–TNF-alpha agents


Vasculitis

• Cutaneous or visceral vasculitis

Sulfonamide antibiotics and diuretics, hydralazine, penicillamine, propylthiouracil


ACE: angiotensin-converting enzyme; NSAIDs: non-steroid anti-inflammatory drugs; SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis; DRESS: Drug rash with eosinophilia and systemic symptoms; DILE: drug-induced lupus erythematosus; ASA: acetylsalicylic acid; PPIs: proton pump inhibitors; TNF: tumour necrosis factor

Warrington and Silviu-Dan Allergy, Asthma & Clinical Immunology 2011 7(Suppl 1):S10   doi:10.1186/1710-1492-7-S1-S10

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