Drug allergy differential diagnosis: Difference between revisions

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===Non-IgE Mediated Drug Allergies===
===Non-IgE Mediated Drug Allergies===
Certain non-IgE mediated conditions need to be differentiated from non-IgE mediated allergic reactions (exanthema, drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, Stevens-johnson syndrome ([[SJS]]), toxic epidermal necrolysis ([[TEN]]).
Certain non-IgE mediated conditions need to be differentiated from non-IgE mediated allergic reactions (exanthema, drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, Stevens-johnson syndrome ([[SJS]]), toxic epidermal necrolysis ([[TEN]]).
*[[Kawasaki disease]]
*[[Still's disease]]
*Acute [[graft-versus-host disease]]
*[[Psoriasis]]
*Insect bites/ stings
* [[Streptococcal]] infection
*[[Viral infection]]

Revision as of 20:05, 16 August 2012


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

Drug Allergy

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Overview

Differentiating Drug Allergy from Other Drug Reactions

Pseudoallergic Reactions

There are reactions called pseudoallergic reactions which, are in the category of adverse drug reactions. Although they mimic drug allergies, immunologic mechanisms have not been demonstrated as an underlying cause. There are also reactions called non-immunologic hypersensitivity reactions for which immunologic mechanisms of reactions have also not been demonstrated.

Some pseudoallergic reactions occur as a result of direct activation of immune cells and inflammatory cells, so the final steps of pathogenesis are the same and the clinical features are similar. Despite the similarities, the diagnosis, prognosis and future prevention are different.

Non-immunologic anaphylaxis can also occur. All types of anaphylaxis are life-threatening. The term “anaphylactoid reaction” often used for non-immunologic anaphylaxis can sometimes be interpreted as less severe, although this is not true. Some patients who show marked dermographism, have profound mast cell instability, which is thought associated with pseudoallergic reactions.

Some agents commonly implicated in pseudoallergic reactions are;

Auto-immune Like Syndromes Caused by Drugs

Lupus like syndromes can be caused by the following medications;

A pemphigus like syndrome can be caused by penicillamine

IgA bullous dermatitis can be caused by:

Differentiating Drug Allergy from Other Conditions

IgE Mediated Drug Allergies

Certain IgE mediated conditions need to be differentiated from IgE mediated drug allergies (angioedema, urticaria, anaphylaxis, bronschospasm);

Non-IgE Mediated Drug Allergies

Certain non-IgE mediated conditions need to be differentiated from non-IgE mediated allergic reactions (exanthema, drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, Stevens-johnson syndrome (SJS), toxic epidermal necrolysis (TEN).