Table 4 Clinical manifestations of drug allergy. [1, 11, 15]
From: Drug allergy
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 |