Drug allergy causes: Difference between revisions

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===Causes by Specific Allergic Reactions===


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cutaneous reactions}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Clnical features}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Implicated medications}}
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Exanthems
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Delayed-type hypersensitivity <BR> Evolve over days after drug initiation <BR> Diffuse macules and papules
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Allopurinol]], [[amphotericin]], [[barbiturates]], [[captopril]], [[carbamazepine]], [[cephalosporins]], [[chloramphenicol]], [[erythromycin]], [[furosemide]], [[gentamicin]], [[gold salts]], [[lithium]], [[nalidixic acid]], [[nitrofurantoin]], [[penicillins]], [[phenothiazines]], [[phenylbutazone]], [[phenytoin]], [[sulfonamides]]), [[thiazides]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Urticaria/ angioedema
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Often IgE mediated <BR> Onset within minutes of drug initiation
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[ACE inhibitors]], [[aminosalicylic acid]], [[anticonvulsants]], [[aspirin]], [[atropine]], [[cephalosporins]], [[dextran]], [[hydralazine]], [[monoclonal antibodies]], [[NSAIDs]], [[opioids]], [[penicillins]], [[pentamidine]], [[quinine]], [[sulfonamides]], [[tetracyclines]], [[thiouracil]], [[tubocurarine]], [[vancomycin]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Fixed drug eruption
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Hyperpigmented plaques that recur at same skin or mucosal site
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[ACE inhibitors]], [[allopurinol]], [[amlodipine]], [[aspirin]], [[barbiturates]], [[benzodiazepines]], [[carbamazepine]], [[cephalosporins]], [[clindamycin]], [[co-trimoxazole]], [[dextromethorphan]], [[diltiazem]], [[fluconazole]], [[lamotrigine]], [[lansoprazole]], [[metronidazole]], [[NSAIDs]], [[paclitaxel]], [[paracetamol]], [[penicillin]], [[phenolphthalein]][[omeprazole]], [[quinine]], [[salicylates]], [[sulfonamides]], [[terbinafine]], [[tetracyclines]], [[trimethoprim]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Pustules
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Acute generalized eczematous pustulosis (AGEP) <BR> Acneiform
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | AGEP: [[antibiotics]], [[calcium-channel blockers]] <BR> Acneiform: [[corticosteroids]], [[sirolimus]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Bullous
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Flaccid blisters <BR> Tense blisters
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Flaccid blisters: [[captopril]], [[penicillamine]] <BR> Tense blisters: [[furosemide]], [[vancomycin]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Cutaneous lupus erythematosus
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Erythematous/scaly plaques in photodistribution
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Hydrochlorothiazide]], [[calcium-channel blockers]], [[ACEIs]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Stevens-Johnson syndrome (SJS)
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Purpuric macules on face and trunk with &lt;10% epidermal detachment, fever, stomatitis, ocular involvement
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[antibiotics]], [[barbiturates]], [[Beta-lactam|β-lactam antibiotics]], [[carbamazepine]], [[chlorpropamide]], [[co-trimoxazole]], [[gold]], [[H2 blocker]], [[histamine]], [[lamotrigine]], [[leflunomide]], [[macrolides]], [[mefloquine]], [[NSAIDs]], [[phenothiazines]], [[phenytoin]], [[rifampicin]], [[sulfonamides]], [[tetracyclines]], [[thiazides]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Toxic epidermal necrolysis (TEN)
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Similar to SJS but >30% epidermal detachment
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Allopurinol]], [[barbiturates]], [[carbamazepine]], [[gold]], [[griseofulvin]], [[lamotrigine]], [[leflunomide]], [[nitrofurantoin]], [[NSAIDs]], [[penicillins]], [[phenytoin]], [[salicylates]], [[sulfonamides]], [[tetracyclines]]
|}


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Organ-specific reactions}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Clnical features}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Implicated medications}}
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Pulmonary
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Pulmonary fibrosis, hypersensitivity pneumonitis
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Nitrofurantoin]], [[bleomycin]], [[methotrexate]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Hepatic
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Hepatitis, cholestasis
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Aminosalicylic acid|Para-aminosalicylic acid]], [[sulfonamides]], [[phenothiazines]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Renal
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Interstitial nephritis, membranous glomerulonephritis
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Penicillin]], [[sulfonamides]], [[gold]], [[penicillamine]], [[allopurinol]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Hematologic
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Hemolytic anemia, thrombocytopenia, granulocytopenia
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Penicillin]], [[quinine]], [[sulfonamides]]
|}


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| style="background: #4479BA; padding: 5px 5px; font-weight: bold;" | {{fontcolor|#FFFFFF|Multiorgan reactions}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Clnical features}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Implicated medications}}
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Anaphylaxis
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Beta-lactam|β-lactam antibiotics]], [[monoclonal antibodies]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Systemic lupus erythematosus
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Arthralgia, myalgias, fever, malaise
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Hydralazine]], [[procainamide]], [[isoniazid]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Vasculitis
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Cutaneous or visceral vasculitis
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Allopurinol]], [[aspirin]], [[Beta-lactam|β-lactam antibiotics]], [[carbamazepine]], [[carbimazole]], [[co-trimoxazole]], [[diltiazem]], [[erythromycin]], [[furosemide]], [[gold]], [[G-CSF]], [[GM-CSF]], [[hydralazine]], [[interferons]], [[methotrexate]], [[minocycline]], [[NSAIDs]], [[penicillamine]], [[propylthiouracil]], [[retinoids]], [[sulfasalazine]], [[sulfonamides]], [[thiazides]], [[thrombolytics]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Serum sickness
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Urticaria, arthralgia, fever
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Heterologous]] [[antibodies]], [[infliximab]]
|-
| style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Drug reaction with eosinophilia and systemic symptoms (DRESS)
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy
| style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Anticonvulsant]]s, [[sulfonamide]]s, [[minocycline]], [[allopurinol]]
|}


==References==
==References==

Revision as of 20:47, 23 September 2014

Drug Allergy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

Overview

The types of drugs that can cause drug allergies vary. Drugs containing sulfa are common in causing drug allergy reactions. Other common drugs implicated in leading to an allergic reaction are antibiotics, insulin, and iodinated drugs.

Causes

Common Causes

When a medication causes an allergic reaction, it is called an allergen. The following is a short list of the most common drug allergens

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Effect Abciximab, Acetazolamide, Allopurinol, Amifostine, Barbiturates, Benazepril, Bendamustine,Benoxaprofen, Betaxolol, Bisoprolol, Brentuximab vedotin, Brinzolamide, Budesonide And Formoterol Fumarate Dihydrate, Bumetanide, Buprenorphine Hydrochloride, Naloxone Hydrochloride, Cabergoline, Captopril, Carbamazepine, Carteolol, Carvedilol, Cefdinir, Celecoxib, Cephalosporins, Chlorambucil, Chlormezanone, Chlorothiazide, Chlorthalidone, Clindamycin, Codeine, Diclofenac, Diltiazem, Erlotinib, Ethotoin, Etravirine, Exenatide, Fosamprenavir, Gold, Ibandronic acid, Ibritumomab tiuxetan, Interferon beta-1b, Ipilimumab, Insulin, Isoniazid, Lamotrigine, Leflunomide, Lenalidomide, Methyldopa, Methylphenidate, Nebivolol, Nevirapine, NSAIDs, Penicillamine, Phenacetin, Phenobarbitol, Phenylbutazone, Phenytoin, Primidone, Procainamide, Quinidine, Sorafenib, Streptomycin, Sulfacetamide sodium And Prednisolone acetate, Sulfasalazine, Sulfonamide, Sulfonylurea, Suramin, Terbinafine, Tetracycline, Thiabendazole, Thioacetazone, Vancomycin, Vandetanib, Zonisamide
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Causes by Specific Allergic Reactions

Cutaneous reactions Clnical features Implicated medications
Exanthems Delayed-type hypersensitivity
Evolve over days after drug initiation
Diffuse macules and papules 		Allopurinol, amphotericin, barbiturates, captopril, carbamazepine, cephalosporins, chloramphenicol, erythromycin, furosemide, gentamicin, gold salts, lithium, nalidixic acid, nitrofurantoin, penicillins, phenothiazines, phenylbutazone, phenytoin, sulfonamides), thiazides
Urticaria/ angioedema Often IgE mediated
Onset within minutes of drug initiation 		ACE inhibitors, aminosalicylic acid, anticonvulsants, aspirin, atropine, cephalosporins, dextran, hydralazine, monoclonal antibodies, NSAIDs, opioids, penicillins, pentamidine, quinine, sulfonamides, tetracyclines, thiouracil, tubocurarine, vancomycin
Fixed drug eruption Hyperpigmented plaques that recur at same skin or mucosal site ACE inhibitors, allopurinol, amlodipine, aspirin, barbiturates, benzodiazepines, carbamazepine, cephalosporins, clindamycin, co-trimoxazole, dextromethorphan, diltiazem, fluconazole, lamotrigine, lansoprazole, metronidazole, NSAIDs, paclitaxel, paracetamol, penicillin, phenolphthaleinomeprazole, quinine, salicylates, sulfonamides, terbinafine, tetracyclines, trimethoprim
Pustules Acute generalized eczematous pustulosis (AGEP)
Acneiform 		AGEP: antibiotics, calcium-channel blockers
Acneiform: corticosteroids, sirolimus
Bullous Flaccid blisters
Tense blisters 		Flaccid blisters: captopril, penicillamine
Tense blisters: furosemide, vancomycin
Cutaneous lupus erythematosus Erythematous/scaly plaques in photodistribution Hydrochlorothiazide, calcium-channel blockers, ACEIs
Stevens-Johnson syndrome (SJS) Purpuric macules on face and trunk with <10% epidermal detachment, fever, stomatitis, ocular involvement antibiotics, barbiturates, β-lactam antibiotics, carbamazepine, chlorpropamide, co-trimoxazole, gold, H2 blocker, histamine, lamotrigine, leflunomide, macrolides, mefloquine, NSAIDs, phenothiazines, phenytoin, rifampicin, sulfonamides, tetracyclines, thiazides
Toxic epidermal necrolysis (TEN) Similar to SJS but >30% epidermal detachment Allopurinol, barbiturates, carbamazepine, gold, griseofulvin, lamotrigine, leflunomide, nitrofurantoin, NSAIDs, penicillins, phenytoin, salicylates, sulfonamides, tetracyclines
Organ-specific reactions Clnical features Implicated medications
Pulmonary Pulmonary fibrosis, hypersensitivity pneumonitis Nitrofurantoin, bleomycin, methotrexate
Hepatic Hepatitis, cholestasis Para-aminosalicylic acid, sulfonamides, phenothiazines
Renal Interstitial nephritis, membranous glomerulonephritis Penicillin, sulfonamides, gold, penicillamine, allopurinol
Hematologic Hemolytic anemia, thrombocytopenia, granulocytopenia Penicillin, quinine, sulfonamides
Multiorgan reactions Clnical features Implicated medications
Anaphylaxis Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension β-lactam antibiotics, monoclonal antibodies
Systemic lupus erythematosus Arthralgia, myalgias, fever, malaise Hydralazine, procainamide, isoniazid
Vasculitis Cutaneous or visceral vasculitis Allopurinol, aspirin, β-lactam antibiotics, carbamazepine, carbimazole, co-trimoxazole, diltiazem, erythromycin, furosemide, gold, G-CSF, GM-CSF, hydralazine, interferons, methotrexate, minocycline, NSAIDs, penicillamine, propylthiouracil, retinoids, sulfasalazine, sulfonamides, thiazides, thrombolytics
Serum sickness Urticaria, arthralgia, fever Heterologous antibodies, infliximab
Drug reaction with eosinophilia and systemic symptoms (DRESS) Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy Anticonvulsants, sulfonamides, minocycline, allopurinol

References

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