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Cutaneous reactions Clnical features Implicated medications
Exanthems Delayed-type hypersensitivity
Evolve over days after drug initiation
Diffuse macules and papules
Allopurinol, amphotericin, barbiturates, captopril, carbamazepine, cephalosporins, chloramphenicol, erythromycin, furosemide, gentamicin, gold salts, lithium, nalidixic acid, nitrofurantoin, penicillins, phenothiazines, phenylbutazone, phenytoin, sulfonamides), thiazides
Urticaria/ angioedema Often IgE mediated
Onset within minutes of drug initiation
ACE inhibitors, aminosalicylic acid, anticonvulsants, aspirin, atropine, cephalosporins, dextran, hydralazine, monoclonal antibodies, NSAIDs, opioids, penicillins, pentamidine, quinine, sulfonamides, tetracyclines, thiouracil, tubocurarine, vancomycin
Fixed drug eruption Hyperpigmented plaques that recur at same skin or mucosal site ACE inhibitors, allopurinol, amlodipine, aspirin, barbiturates, benzodiazepines, carbamazepine, cephalosporins, clindamycin, co-trimoxazole, dextromethorphan, diltiazem, fluconazole, lamotrigine, lansoprazole, metronidazole, NSAIDs, paclitaxel, paracetamol, penicillin, phenolphthaleinomeprazole, quinine, salicylates, sulfonamides, terbinafine, tetracyclines, trimethoprim
Pustules Acute generalized eczematous pustulosis (AGEP)
Acneiform
AGEP: antibiotics, calcium-channel blockers
Acneiform: corticosteroids, sirolimus
Bullous Flaccid blisters
Tense blisters
Flaccid blisters: captopril, penicillamine
Tense blisters: furosemide, vancomycin
Cutaneous lupus erythematosus Erythematous/scaly plaques in photodistribution Hydrochlorothiazide, calcium-channel blockers, ACEIs
Stevens-Johnson syndrome (SJS) Purpuric macules on face and trunk with <10% epidermal detachment, fever, stomatitis, ocular involvement antibiotics, barbiturates, β-lactam antibiotics, carbamazepine, chlorpropamide, co-trimoxazole, gold, H2 blocker, histamine, lamotrigine, leflunomide, macrolides, mefloquine, NSAIDs, phenothiazines, phenytoin, rifampicin, sulfonamides, tetracyclines, thiazides
Toxic epidermal necrolysis (TEN) Similar to SJS but >30% epidermal detachment Antibacterial sulfonamides, oxicam NSAIDs, anticonvulsants, allopurinol


Organ-specific reactions Clnical features Implicated medications
Pulmonary Pulmonary fibrosis, hypersensitivity pneumonitis Nitrofurantoin, bleomycin, methotrexate
Hepatic Hepatitis, cholestasis Para-aminosalicylic acid, sulfonamides, phenothiazines
Renal Interstitial nephritis, membranous glomerulonephritis Penicillin, sulfonamides, gold, penicillamine, allopurinol
Hematologic Hemolytic anemia, thrombocytopenia, granulocytopenia Penicillin, quinine, sulfonamides


Multiorgan reactions Clnical features Implicated medications
Anaphylaxis Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension β-lactam antibiotics, monoclonal antibodies
Systemic lupus erythematosus Arthralgia, myalgias, fever, malaise Hydralazine, procainamide, isoniazid
Vasculitis Cutaneous or visceral vasculitis Allopurinol, aspirin, β-lactam antibiotics, carbamazepine, carbimazole, co-trimoxazole, diltiazem, erythromycin, furosemide, gold, G-CSF, GM-CSF, hydralazine, interferons, methotrexate, minocycline, NSAIDs, penicillamine, propylthiouracil, retinoids, sulfasalazine, sulfonamides, thiazides, thrombolytics
Serum sickness Urticaria, arthralgia, fever Heterologous antibodies, infliximab
Drug reaction with eosinophilia and systemic symptoms (DRESS) Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy Anticonvulsants, sulfonamides, minocycline, allopurinol


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References

  1. Khan, David A. (2010-02). "Drug allergy". The Journal of Allergy and Clinical Immunology. 125 (2 Suppl 2): –126-137. doi:10.1016/j.jaci.2009.10.028. ISSN 1097-6825. PMID 20176256. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  2. Lee, Anne (2006). Adverse drug reactions. London Chicago: Pharmaceutical Press. ISBN 0853696012.