Table 4 Clinical manifestations of drug allergy [1, 12, 16]

Skin

 Exanthemata

•Diffuse, fine macules and papules

•Evolve over days post drug initiation

Allopurinol, penicillins, cephalosporins, anticonvulsants, sulfonamides, mAbs

 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, mAbs

 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, mAbs

 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, mAbs

 Serum sickness

•Urticaria, arthralgias, fever

Heterologous antibodies, infliximab, allopurinol, thiazides, antibiotics (e.g., cefaclor), bupropion, mAbs

 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, mAbs