Drug allergy laboratory findings: Difference between revisions
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{{CMG}} {{AE}} {{CP}} | {{CMG}} {{AE}} {{CP}} | ||
{{Drug allergy}} | {{Drug allergy}} | ||
==Overview== | ==Overview== | ||
Drug allergy is primarily a clinical diagnosis based on the patient history, and a thorough physical exam. Certain laboratory findings may be seen during the acute phase of the reaction, but are not always specific. Skin testing and biopsies can be performed when there is not a clear diagnosis. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
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* White blood cell ([[WBC]]) may be increased. | * White blood cell ([[WBC]]) may be increased. | ||
*Urine [[eosinophils]] may be increased, especially in cases of [[allergic interstitial nephritis]]. | *Urine [[eosinophils]] may be increased, especially in cases of [[allergic interstitial nephritis]]. | ||
*[[ | *Blood [[eosinophils]] may be increased, especially in cases of drug induced [[TEN]]. | ||
*Liver function tests ([[LFT]])'s may be increased. | *Liver function tests ([[LFT]])'s may be increased. | ||
*Elevations in [[tryptase]] may be seen detected in serum or plasma within several hours after an acute allergic event, and is consistent with [[anaphylaxis]]. | |||
* [[Histamine]] levels may be elevated after an acute reaction, but is unreliable for [[diagnosis]]. | |||
*[[Complete blood count]] – a complete blood count (CBC) is useful in ruling out hemolytic type II drug reactions, such as [[hemolytic anemia]], [[thrombocytopenia]] or [[neutropenia]]. | |||
*[[Coombs test]]- the indirect and direct Coomb’s test is used to determine the presence of [[antibodies]] on red cell membranes. This test can also be useful in confirming hemolytic anemia. <ref name="pmid19563988">{{cite journal| author=Schnyder B| title=Approach to the patient with drug allergy. | journal=Immunol Allergy Clin North Am | year= 2009 | volume= 29 | issue= 3 | pages= 405-18 | pmid=19563988 | doi=10.1016/j.iac.2009.04.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19563988 }} </ref> | |||
*[[Basophil]] activation test- this test quantifies the activation of basophils using flow cytometry. Basophils are implicated in the development of both immune and non-immune mediated drug reactions. Some studies have shown that this test is useful in evaluating allergy towards beta-lactam [[antibiotics]], [[muscle relaxants]], and [[NSAIDS]], however further studies are needed before this type of testing is widely accepted as a diagnostic tool. <ref name="pmid19563997">{{cite journal| author=Hausmann OV, Gentinetta T, Bridts CH, Ebo DG| title=The basophil activation test in immediate-type drug allergy. | journal=Immunol Allergy Clin North Am | year= 2009 | volume= 29 | issue= 3 | pages= 555-66 | pmid=19563997 | doi=10.1016/j.iac.2009.04.011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19563997 }} </ref> | |||
==References== | |||
{{reflist|2}} | |||
[[Category:Allergology]] | |||
[[Category:Immunology]] | |||
[[Category:Emergency medicine]] | |||
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Latest revision as of 21:25, 13 February 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]
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Overview
Drug allergy is primarily a clinical diagnosis based on the patient history, and a thorough physical exam. Certain laboratory findings may be seen during the acute phase of the reaction, but are not always specific. Skin testing and biopsies can be performed when there is not a clear diagnosis.
Laboratory Findings
- Erythrocyte sedimentation rate (ESR) may be increased.
- White blood cell (WBC) may be increased.
- Urine eosinophils may be increased, especially in cases of allergic interstitial nephritis.
- Blood eosinophils may be increased, especially in cases of drug induced TEN.
- Liver function tests (LFT)'s may be increased.
- Elevations in tryptase may be seen detected in serum or plasma within several hours after an acute allergic event, and is consistent with anaphylaxis.
- Histamine levels may be elevated after an acute reaction, but is unreliable for diagnosis.
- Complete blood count – a complete blood count (CBC) is useful in ruling out hemolytic type II drug reactions, such as hemolytic anemia, thrombocytopenia or neutropenia.
- Coombs test- the indirect and direct Coomb’s test is used to determine the presence of antibodies on red cell membranes. This test can also be useful in confirming hemolytic anemia. [1]
- Basophil activation test- this test quantifies the activation of basophils using flow cytometry. Basophils are implicated in the development of both immune and non-immune mediated drug reactions. Some studies have shown that this test is useful in evaluating allergy towards beta-lactam antibiotics, muscle relaxants, and NSAIDS, however further studies are needed before this type of testing is widely accepted as a diagnostic tool. [2]
References
- ↑ Schnyder B (2009). "Approach to the patient with drug allergy". Immunol Allergy Clin North Am. 29 (3): 405–18. doi:10.1016/j.iac.2009.04.005. PMID 19563988.
- ↑ Hausmann OV, Gentinetta T, Bridts CH, Ebo DG (2009). "The basophil activation test in immediate-type drug allergy". Immunol Allergy Clin North Am. 29 (3): 555–66. doi:10.1016/j.iac.2009.04.011. PMID 19563997.