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