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Adverse Drug Reaction

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Adverse Drug Reaction, Medication Hypersensitivity, Drug Reaction, Medication Allergic Reaction, Drug Hypersensitivity, Drug Eruption, Drug-Induced Skin Reaction, Cutaneous Drug Eruption

  • Risk factors
  • Immune-mediated Drug Reaction
  1. Drug Hypersensitivity Reaction to related medication
  2. Adults (especially women)
  3. Concurrent Viral Infection
  4. Comorbid condition
    1. HIV Infection
    2. Asthma
    3. Systemic Lupus Erythematosus
    4. Beta Blocker use
  5. Medications with larger more complicated structure
    1. Non-human Proteins
    2. Streptokinase
    3. Insulin
  • Findings
  • Suggestive of Drug Hypersensitivity
  1. See Life-Threatening Drug-Induced Rashes
  2. Anaphylaxis
  3. Angioedema
  4. Urticaria
  5. Morbilliform rash (80% of drug rashes in adults, 35% in children)
    1. Occurs 4 to 21 days after onset of exposure
    2. See Fixed Drug Eruption
  6. Bullous Disease
    1. See Drug-Induced Bullous Disease
    2. Erythema Multiforme
    3. Toxic Epidermal Necrolysis
  • Management
  1. Avoid drug responsible for adverse reaction
  2. Consider testing for allergy if suspect immune-mediated
    1. Type 1 Hypersensitivity Reaction
      1. Skin Testing
      2. RAST Testing
    2. Type 2 Hypersensitivity Reaction
      1. Coombs' Test positive
      2. Complete Blood Count
        1. Hemolytic Anemia
        2. Thrombocytopenia
        3. Neutropenia
    3. Type 3 Hypersensitivity Reaction
      1. Erythrocyte Sedimentation Rate (ESR) increased
    4. Type 4 Hypersensitivity Reaction
      1. Patch Testing
  3. Consider Desensitization to offending agent
  4. Consider specific agent management
    1. Penicillin Adverse Drug Reaction
    2. Intravenous Contrast