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]

• Swelling

  […] in the urine, general swelling, confusion and other symptoms When to see a doctor Call 911 or emergency medical help if you experience signs of a severe reaction or suspected anaphylaxis after taking a medication. [mayoclinic.org]

  A less common but more serious, sudden-onset allergic reaction to penicillin is anaphylaxis,  Swelling of the tongue, throat, nose and lips  Dizziness and fainting or loss of consciousness  Tightness in the chest and difficulty breathing 13. [slideshare.net]

  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]

  Examples are Rashes and itching Fever Constriction of the airways and wheezing Swelling of tissues (such as the voice box [larynx] and the opening between the vocal cords that closes to stop the flow of air to the lungs [glottis]), which impairs breathing [msdmanuals.com]

• 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]

• Dentist

  Inform other health care providers, such as your dentist or any medical specialist. Wear a bracelet. Wear a medical alert bracelet that identifies your drug allergy. This information can ensure proper treatment in an emergency. [mayoclinic.org]

• Acutely Ill Patient

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

• Cough

  Pencillin allergy symptoms Hives angioedema Throat tightness Wheezing Coughing Trouble breathing 12. [slideshare.net]

  The next day the patient was feeling slightly better; he was afebrile though cough and eosinophilic leukocytosis persisted. [ncbi.nlm.nih.gov]

  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]

  Since a week ago, patient experienced productive cough, with white mucous, no blood, left chest pain is felt especially when coughing. Fever experienced since one week, especially at night, no chills, no seizures and no headache. [omicsonline.org]

  Renal failure is rare Inflammation of the heart (myocarditis) or heart sac (pericarditis), causing chest pain, breathlessness and lowered blood pressure Lung disease, causing shortness of breath and cough (interstitial pneumonitis, pleuritis, pneumonia [dermnetnz.org]

• Dyspnea

  Pulmonary involvement was considered when dyspnea or abnormal findings on chest radiographs were present and could not be explained by other reasons. [doi.org]

  The assessment of rashes The following can be warning signs of a serious reaction carrying an elevated mortality: a bullous skin reaction, facial and mucosal involvement, eosinophilia, elevated liver enzymes, dyspnea, and systemic symptoms such as fever [ncbi.nlm.nih.gov]

• Respiratory Distress

  Additionally, hypotension, bleeding, interstitial nephritis, arthralgia, arthritis, myositis, thyroiditis, pneumonitis, respiratory distress syndrome, pericarditis, myocarditis, pancreatitis, colitis, orchitis, encephalitis, and aseptic meningitis have [mdedge.com]

  distress syndrome) Neurological involvement, which may lead to meningitis and, encephalitis, polyneuritis, causing headache, seizures, coma and palsies Gastrointestinal symptoms: gastroenteritis, pancreatitis, bleeding and dehydration. [dermnetnz.org]

  Lung involvement takes the form of interstitial pneumonitis, pleuritis, or the acute respiratory distress syndrome; minocycline and abacavir are the main culprit drugs causing severe lung involvement. [en.wikipedia.org]

  distress caused by airway swelling and closing and may be followed by a rapid drop in blood pressure and shock.5,6 Gastrointestinal distress may also occur.2,5,6 Nearly all drugs can cause this type of immune reaction. [uspharmacist.com]

• 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]

• Nasal Congestion

  Oral H1-receptor blockers are helpful for controlling itchiness, rhinorrhea, and lacrimation but most have little effect on nasal congestion. Administer an intranasal glucocorticosteroid to control nasal symptoms, including nasal congestion. [emedicine.medscape.com]

  In cases of acute NERD, rhinorrhea and nasal congestion followed by dyspnea and chest tightness appear within 30 to 120 minutes after administration of NSAIDs. [kjim.org]

• 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]

• Constipation

  Also rashes and constipation turned out to be unexpected effects of the drug [40, 49]. When thalidomide was withdrawn in most countries in 1961–1962, more than 10,000 children with partially severe malformation had already been born [41, 42]. [intechopen.com]

• 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]

• Dermatitis

  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]

  For instance, contact dermatitis is a type IV delayed-type hypersensitivity reaction to skin allergens. An estimated 15%-20% of the general population has acquired contact allergy. [ncbi.nlm.nih.gov]

  Systemic steroids may have some beneficial effects Systemic corticosteroids are generally used in the more severe DHS cases involving significant exfoliative dermatitis, pneumonitis and/or hepatitis.3 Relapses may occur as corticosteroid doses are tapered [medsafe.govt.nz]

• 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]

• 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]

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]