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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
  1. 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