drug allergy
TRANSCRIPT
Drug AllergyBy :
DESSY ADELIANA
Definition Drug allergy is an immunologically
mediated response to a pharmaceutical and/or formulation (excipient) agent in a sensitized person.
Roland Solensky, David A. Khan. Drug Allergy: An Updated Practice Parameter. Annals Of Allergy, Asthma & Immunology. 2010;105:273
Risk factors Drug-related factors
• Nature of the drug• Degree of exposure (dose, duration, frequency) • Route of administration • Cross-sensitization
Host-related factors• Age • Sex • Genetic factors (HLA type, Acetylator status) • Concurrent medical illness (e.g. Ebstein-Barr Virus (EBV),
human immunodeficiency virus (HIV), asthma) • Previous drug reaction • Multiple drug allergy syndrome
Thong BY, Tan TC. Epidemiology and risk factors for drug allergy. Br J Clin Pharmacol 2011; 71:684-700.
Classification of Adverse Drug Reaction
Drugs Allergies
Benno Schnyder , Werner J.Pichler. Mechanisms of Drug-Induced Allergy. Mayo Clin Pro. 2009;84(3):268-272
Type I drug hypersensitivity
Type II drug hypersensitivity
Diagnosis Based on a detailed history of the onset of
symptoms/signs combined with a temporal relationship between the appearance of those symptoms and drug use/discontinuation.
Marc.A.Riedl, Adrian M.Casillas. Adverse Drug Reactions : Types and treatment options.American Family Physician.2003;68: 1786
Diagnostic test IgE mediated or not Measurement of mediators
- histamine- tryptase- leukotrienes
Measurement of drug-specific IgElevel: •measured by RAST or RIA
Thong BY, Vervloet D.Drug Allergies. FAAAAI.2014
Diagnostic testSkin testuseful in the diagnosis of Ig-E mediated allergy
•skin prick test•intradermal test
Thong BY, Vervloet D.Drug Allergies. FAAAAI.2014
Treatment Acute Immediate Management of IgE-Mediated Reactions Nonserious (mild cutaneous)
reactions: antihistamines
Serious reactions (anaphylaxis): emergency management A-B-C • IM epinephrine 0.3 mL of a 1:1,000 concentration up to
every 5 minutes in adults or 0.01 mg/kg in children up to a maximum dose of 0.3 mg
• IM promethazine or intravenous diphenhydramine Intravenous fluids (colloids or crystalloids)
Thong BY, Vervloet D.Drug Allergies. FAAAAI.2014
Acute Immediate Management of Non–IgE-Mediated Reactions Nonserious reactions: antihistamines Serious reactions
TEN: High-dose intravenous immunoglobulin (IVIG 1 g/kg/d for 2 days)
Thong BY, Vervloet D.Drug Allergies. FAAAAI.2014
Spesific TreatmentDrug desensitization for IgE-mediated drug allergy
Thong BY, Vervloet D.Drug Allergies. FAAAAI.2014
PREVENTION Patients and family members should
be educated on the generic names of the drugs they are allergic to and other potentially cross-reacting drugs
Thong BY, Vervloet D.Drug Allergies. FAAAAI.2014
PROGNOSIS
Drug-induced anaphylaxis is potentially fatal. In SJS/TEN, the reported mortality rate varies
from 30% to 50%. Ocular complications (i.e., nonhealing epithelial defects and visual impairment) SJS/TEN. Persistent dry eyes is the most common.
Thong BY, Vervloet D.Drug Allergies. FAAAAI.2014
Summary Drug hypersensitivity results from
interactions between a pharmacologic agent and the human immune system.
Immune-mediated drug hypersensitivity reactions typically pose a predictable, more serious health risk with re-exposure to a drug
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