Predictors of DHRs against asparaginase and other biological agents relate to antigen presentation (HLA-DRB1 and HLA-A alleles, respectively). [ncbi.nlm.nih.gov]

• Generalized Lymphadenopathy

  Howard Libman, Generalized lymphadenopathy, Journal of General Internal Medicine, 10.1007/BF02596251, 2, 1, (48-58), (1987). M. J. Eadie, The Risk-Benefit Ratio of Anticonvulsant Drugs, Medical Toxicology, 2, 5, (324), (1987). J.P. [doi.org]

  Tender local (usually involving cervical nodes) or generalized lymphadenopathy (usually axillary, cervical and inguinal nodes) is another common feature of the initial presentation of DHS. [ijdvl.com]

• Fever

  This syndrome is a severe, idiosyncratic multi-system reaction defined by the clinical triad of fever, rash and internal organ involvement (e.g. hepatitis, myocarditis, nephritis or pneumonitis), which may occur 1 - 8 weeks after medicine exposure.1 Fever [medsafe.govt.nz]

  Within 24 hours his fever resolved. Over the following week his liver enzymes, C reactive protein concentration, and skin returned to normal. [bmj.com]

  A high fever of 38–40 C is usually noticed first. This is quickly followed by a widespread skin rash. Characteristics of the rash are diverse. [dermnetnz.org]

• Malaise

  The most common presentations in patients with DHS are fever, which ranges from 38°C to 40°C and occurs in 85% of cases, malaise, pharyngitis, and cervical lymphadenopathy. [mdedge.com]

  As with serum sickness, the rash is usually preceded by a prodromal phase consisting of fever, malaise, and lymphadenopathy. Viral infections must be ruled out, as they can mimic SSLR. [uspharmacist.com]

  The syndrome may be mild (with arthralgias, fever, and rash) or fairly dramatic (with serositis, high fevers, and malaise), but it tends to spare the kidneys and central nervous system. The antinuclear antibody test is positive. [msdmanuals.com]

• Acutely Ill Patient

  Reduced levels of glutathione, selenium and other potentially important antioxidant nutrients occur in acutely ill patients with HIV. 4. [ijdvl.com]

• Unconsciousness

  Opioid-intoxication, as for example a morphine overdose leads to unconsciousness, hypoventilation and miosis. The probability of an ADE differs from substance to substance. [intechopen.com]

• Intravenous Administration

  Another factor affecting the frequency of hypersensitivity drug reactions is the route of drug administration; topical, intramuscular, and intravenous administrations are more likely to cause hypersensitivity reactions. [aafp.org]

• Sneezing

  Allergic reactions can range from the mild (sneezing and runny nose, or a few hives) to the severe (anaphylaxis or cardiopulmonary arrest). [brighamandwomens.org]

  Allergic rhinitis: Release of the above mediators in the upper respiratory tract can result in sneezing, itching, nasal congestion, rhinorrhea, and itchy or watery eyes. [emedicine.medscape.com]

• Nausea

  These conditions include: Serum sickness, which may cause fever, joint pain, rash, swelling and nausea Drug-induced anemia, a reduction in red blood cells, which can cause fatigue, irregular heartbeats, shortness of breath and other symptoms Drug rash [mayoclinic.org]

  Wait about an hour before lying down Patients should protect skin and nails from sun exposure, as it is photosensitising and can cause unexpected sunburn It can cause nausea, vomiting and diarrhoea; it is better tolerated when taken after food than on [dermnetnz.org]

  Two weeks following therapy, the patient developed fever, skin rash, nausea, and headache. The next day, the patient became anuric. There was no family history of renal or hepatic disease. [mdedge.com]

  No nausea and vomiting, loss of appetite three days before entering the hospital. Patients gained weight in the last six months but previously experienced a weight loss of about 5-10 kg in five years. Normal urination and defecation. [omicsonline.org]

• Abdominal Pain

  A pearl is patients may present with only recurrent episodes of abdominal pain with GI distress (n/v/d) secondary to gut edema. [imrespdx.com]

  pain, diarrhea, hepatomegaly, splenomegaly Skin rash (maculopapular rash, bullous, wheal and flare, plaque, patch, target lesion) Internal organ involvement (liver - elevated alanine aminotransferase levels, kidney, lung); also brain ( Turk J Pediatr [pathologyoutlines.com]

  Drug-induced liver damage Typical externally evident signs of severe liver damage include fatigue, weakness, abdominal pain, nausea, dark urine, jaundice, pruritus, and fever. [ncbi.nlm.nih.gov]

• Aphthous Stomatitis

  Doxycycline is also effective at controlling non-infectious, inflammatory skin and mucosal diseases, including: Acne Rosacea Perioral dermatitis Hidradenitis suppurativa Recurrent aphthous stomatitis Bullous pemphigoid Granulomatous disorders such as [dermnetnz.org]

• Arthralgia

  Diagnosis of AIN should be considered in any case of rapidly progressive renal failure occurring during drug therapy, especially when fever, skin rash, arthralgias, macroscopic hematuria, and blood or urinary eosinophilia are present. [ncbi.nlm.nih.gov]

  Some distinct clinical syndromes can involve other types of hypersensitivity reactions: Serum sickness: This reaction typically occurs 7 to 10 days after exposure and causes fever, arthralgias, and rash. [msdmanuals.com]

  […] other organ systems may be involved, including the renal, hepatic, and hemolytic systems.2 Multi-organ reactions may also occur, and include anaphylaxis.2 Serum sickness is an immune-complex-mediated reaction that presents with fever, lymphadenopathy, arthralgia [thermofisher.com]

• Urticaria

  The present study aimed to investigate the relationship between NH and chronic urticaria, rhinitis/rhinosinusitis, and asthma in an effort to identify NH phenotypes. [ncbi.nlm.nih.gov]

• Skin Rash

  The syndrome is defined by the clinical triad of fever, skin rash and internal organ involvement and can be life-threatening condition. We describe three patients treated in our institution. [ncbi.nlm.nih.gov]

  This is quickly followed by a widespread skin rash. Characteristics of the rash are diverse. [dermnetnz.org]

• Pruritus

  This is a case of a young person who initially presented with a dramatic episode of unilateral arm swelling after injuring a finger, with subsequent episodes of recurrent localized edema without pruritus throughout their body, including episodes of gut [imrespdx.com]

  Immediate reactions Immediate reactions have variable manifestations, ranging from pruritus to edema, urticaria, and anaphylactic shock. [ncbi.nlm.nih.gov]

• Eczema

  Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006 Aug 26. 368(9537):733-43. [Medline]. [emedicine.medscape.com]

  Common morphologies include urticaria, angioedema, maculopapular exanthema (MPE), fixed drug eruption, eczema, photodermatoses, erythema multiforme, generalized exfoliative dermatitis, acute generalized exanthematous pustulosis (AGEP), erythroderma, cutaneous [worldallergy.org]

  […] eosinophilia and systemic symptoms (DRESS) Stevens-Johnson syndrome / Lyell syndrome (synonym: toxic epidermal necrolysis) (SJS/TEN) drug-induced liver injury (DILI) drug-induced renal injury (DIRI) Contact allergies of the skin, usually consisting of contact eczema [ncbi.nlm.nih.gov]

• Chronic Urticaria

  The present study aimed to investigate the relationship between NH and chronic urticaria, rhinitis/rhinosinusitis, and asthma in an effort to identify NH phenotypes. [ncbi.nlm.nih.gov]

  Molecular genetic mechanisms of chronic urticaria. Allergy Asthma Immunol Res 2014;6:13–21. 50. Sanak M, Pierzchalska M, Bazan-Socha S, Szczeklik A. [kjim.org]

  Forty-one patients were excluded: 27 because of a clinical history incompatible with a drug hypersensitivity reaction, 6 because of HIV, 2 because of chronic urticaria, 4 because of food or latex allergy, and 2 because of severe cutaneous reactions. [jamanetwork.com]

  urticaria refractory to high dose treatment with H1 antihistamines (ref60) and is now FDA approved for refractory chronic urticaria. [emedicine.medscape.com]

• Fear

  Despite its effectiveness, many people avoid penicillin and its relatives fearing a severe allergic reaction, where symptoms can include wheezing, coughing, breathing problems, tissue swelling, or in some serious cases anaphylaxis, requiring urgent medical [news-medical.net]

  Drug hypersensitivity reactions can indeed be life-threatening,1,2 and drug reintroduction in these patients may cause reactions that may be even more severe.2,3 On the other hand, overdiagnosis due to common fear of anaphylaxis is frequent, and nonhypersensitive [jamanetwork.com]

  Lack of knowledge and experience in this important area can lead to fear of multiple “drug allergies” and unnecessary avoidance of appropriate medications, with reliance on more expensive, or less effective, alternatives without a rational basis. [mja.com.au]

• Headache

  These include: Drug hypersensitivity syndrome Autoimmune reactions Dizziness and headache After prolonged use, blue pigmentation of skin and nails Minocycline is less likely than doxycycline to cause photosensitivity. [dermnetnz.org]

  Two weeks following therapy, the patient developed fever, skin rash, nausea, and headache. The next day, the patient became anuric. There was no family history of renal or hepatic disease. [mdedge.com]

• Irritability

  Nonimmune-Related Drug Reactions Irritant Contact Dermatitis: Irritant contact dermatitis is the result of friction; overexposure to elements such as water, heat, or cold; or exposure to tapes, chemicals, solvents, or detergents. [uspharmacist.com]

  In this regard, the EUgd [6] indicate that the irritating potential of all NSAIDs appears to be low in SPTs, and the specificity is thus high (>95%); for IDTs, up to 0.1 mg/mL appear to not irritate the skin. [ctajournal.biomedcentral.com]

  Recommendations on non-irritating skin test concentrations for SPT, IDT and patch tests have been published. [worldallergy.org]

  Keune Keune Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) Kevin Murphy (ICON) KMS KMS KMS KMS KMS KMS KMS kMS kMS 1 irrit [dokodoc.com]

  Sensory irritation and multiple chemical sensitivity. Toxicol Ind Health. 1999 Apr-Jun;15(3-4):339-45. https://www.ncbi.nlm.nih.gov/pubmed/10416286 Anderson RC, Anderson JH. Acute toxicity of marking pen emissions. [freeweb.t-2.net]

• Stroke

  Neelima Vidula, Nashmia Qamar, Christopher Kurahashi, Vinky Chadha, Daniel Evans and Anju Peters, Encephalopathy and strokes secondary to drug reaction with eosinophilia and systemic symptoms: A case report, The Journal of Allergy and Clinical Immunology [oadoi.org]

In this study, we aimed to assess the frequency of confirmed NSAID hypersensitivity in children with a previous reported reaction to NSAID in order to investigate the role of the drug provocation test (DPT) in the diagnostic workup and to explore the [ncbi.nlm.nih.gov]

See this previous report for the differential of bilateral lower extremity edema. 2) C3 and C4 complement levels can be used in a workup of vasculitis to help distinguish pauci-immune vasculidities (they are normal). 3) Hereditary angioedema is an extremely [imrespdx.com]

Considering that treatment for tuberculosis requires long-term management with several drugs, it is important to refrain from administering drugs that can cause DIHS during tuberculosis treatment. [ncbi.nlm.nih.gov]

Treatment is drug discontinuation, supportive treatment (eg, with antihistamines), and sometimes desensitization. [msdmanuals.com]

The clinical recognition that GCM may be a manifestation of an adverse drug reaction is important, since the prognosis and treatment of this entity may be different from that of other forms of myocarditis. [ncbi.nlm.nih.gov]

The effect of corticosteroids on prognosis is unknown as controlled clinical trials are lacking.2 Beware of cross-reactions and family predisposition Cross-hypersensitivity reactions are common between the three main aromatic anticonvulsants (i.e. phenytoin [medsafe.govt.nz]

Samter's triad include asthma, aspirin sensitivity, and nasal/ethmoidal polyposis: ASP irin A sthma S ensitivity to aspirin P olyps T T oxic epidermal necrosis (TEN) T hirty percent of the skin (SJS less than 10%) " T errible" prognosis Management of [allergycases.blogspot.com]

Inpatient vancomycin use is increasing and appears to be emerging as an important etiology of DRESS syndrome. This study highlights the importance of vancomycin as a cause of DRESS syndrome. [doi.org]

The classification and etiology of hypersensitivity reactions The etiology of type I allergic reactions Type I allergy involves the IgE-mediated elaboration of inflammatory mediators such as histamine, heparin, tryptase, platelet-activating factor, and [ncbi.nlm.nih.gov]

We review the epidemiology of severe drug hypersensitivity reactions with a particular focus on severe cutaneous adverse reactions (SCARs). [ncbi.nlm.nih.gov]

Besides epidemiological aspects, it addresses the immunological mechanisms underlying these complicated reactions which go far beyond the IgE-mediated drug allergies also considered in the book. [karger.com]

This review focuses on the current knowledge of the epidemiology, pathophysiology and clinical features of drug hypersensitivity reactions of drugs used in the management of the HIV -infected patient. [journals.lww.com]

The increased predisposition of drug hypersensitivity disease in HIV will continue to provide a fertile ground for study of the diverse and complex processes that drive its pathophysiology. [journals.lww.com]

Drug hypersensitivity reactions still remain one of the most challenging problems in allergology due to their manifold clinical manifestations and their very diverse pathophysiology. [ncbi.nlm.nih.gov]

[…] is unknown The underlying mechanisms causing DHS are poorly understood.1 Defective detoxification of reactive oxidative metabolites1 and a genetic predisposition4 have been implicated in the pathophysiology of this syndrome, as has slow acetylator status [medsafe.govt.nz]

Elucidating the mechanisms of drug hypersensitivity will not only help to identify patients at risk but will also provide novel insights into the pathophysiology of numerous immune-mediated diseases. [karger.com]

Articles in this issue include: Drug allergy diagnosis; Principles of drug allergy management: acute drug reactions, individual preventive measures, desensitization, general preventive measures; Antibiotics allergy; Non-steroidal anti-inflammatory drugs [books.google.com]

HLA-B*57:01 screening to prevent abacavir hypersensitivity exemplifies a successful translational roadmap from pharmacogenomic discovery through to widespread clinical implementation. [ncbi.nlm.nih.gov]