Drug allergy physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} {{AE}} {{CP}} | {{CMG}} {{AE}} {{CP}} | ||
{{Drug allergy}} | {{Drug allergy}} | ||
==Overview== | ==Overview== | ||
Findings on [[physical examination]] will vary widely in drug allergy, depending on the specific manifestation of the type of drug allergy ([[Stevens-Johnson syndrome]], [[toxic epidermal necrolysis]]), and the severity of the allergic reaction. A full, comprehensive physical examination should be performed to distinguish drug allergy from any other causes and conditions, and particular attention should be given to the [[respiratory]] and [[cardiovascular]] systems to quickly recognize impending life-threatening reactions. | |||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
This will vary depending on the severity of the reaction. Patient may be uncomfortable, itchy, or may just have a very localized area of redness. They may have a rash or lesions that are visible on first glance, and if they are experiencing bronchospasm or angioedema, they may be visibly short of breath. | This will vary depending on the severity of the reaction. Patient may be uncomfortable, itchy, or may just have a very localized area of redness. They may have a [[rash]] or lesions that are visible on first glance, and if they are experiencing [[bronchospasm]] or [[angioedema]], they may be visibly short of breath. They may also appear fatigued, with redness of the skin and eyes. | ||
==Vitals== | ===Vitals=== | ||
===Temperature=== | ====Temperature==== | ||
*A [[fever]] may be present | *A [[fever]] may be present | ||
===Pulse=== | ====Pulse==== | ||
====Rate==== | =====Rate===== | ||
*[[Tachycardia]] may be present in cases that develop into anaphylactic shock. | *[[Tachycardia]] may be present in cases that develop into anaphylactic shock. | ||
====Rhythm==== | =====Rhythm===== | ||
*The pulse is regular | *The pulse is regular | ||
====Strength==== | =====Strength===== | ||
*The pulse may be weak | *The pulse may be weak | ||
===Blood Pressure=== | ====Blood Pressure==== | ||
*[[Hypotension]] may be present in cases leading to anaphylactic shock | *[[Hypotension]] may be present in cases leading to anaphylactic shock | ||
===Respiratory Rate=== | ====Respiratory Rate==== | ||
*[[Tachypnea]] may be present | *[[Tachypnea]] may be present | ||
*[[Bradypnea]] may be present | *[[Bradypnea]] may be present | ||
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===Head=== | ===Head=== | ||
*There may be an area of localized redness in a contact dermatitis skin allergy | *There may be an area of localized redness in a [[contact dermatitis]] skin allergy | ||
===Eyes=== | ===Eyes=== | ||
*Conjunctivitis with redness and tearing of the eye may be seen | *[[Conjunctivitis]] with redness and tearing of the eye may be seen | ||
===Throat=== | ===Throat=== | ||
*[[Sore throat]] can be seen in [[Stevens-Johnson syndrome]] and [[toxic epidermal necrolysis]]. | |||
* [[Angioedema]] may be seen | |||
*[[Bronchospasm]] may be noted | |||
===Neck=== | ===Neck=== | ||
*[[Lymphadenopathy]] may be | *[[Lymphadenopathy]] may be present in [[DRESS syndrome]] (drug rash with eosinophilia and systemic symptoms syndrome) | ||
==References== | |||
{{reflist|2}} | |||
[[Category:Allergology]] | |||
[[Category:Immunology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Needs content]] | |||
{{WH}} | |||
{{WS}} | |||
Latest revision as of 21:53, 21 September 2015
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
Findings on physical examination will vary widely in drug allergy, depending on the specific manifestation of the type of drug allergy (Stevens-Johnson syndrome, toxic epidermal necrolysis), and the severity of the allergic reaction. A full, comprehensive physical examination should be performed to distinguish drug allergy from any other causes and conditions, and particular attention should be given to the respiratory and cardiovascular systems to quickly recognize impending life-threatening reactions.
Physical Examination
Appearance of the Patient
This will vary depending on the severity of the reaction. Patient may be uncomfortable, itchy, or may just have a very localized area of redness. They may have a rash or lesions that are visible on first glance, and if they are experiencing bronchospasm or angioedema, they may be visibly short of breath. They may also appear fatigued, with redness of the skin and eyes.
Vitals
Temperature
- A fever may be present
Pulse
Rate
- Tachycardia may be present in cases that develop into anaphylactic shock.
Rhythm
- The pulse is regular
Strength
- The pulse may be weak
Blood Pressure
- Hypotension may be present in cases leading to anaphylactic shock
Respiratory Rate
- Tachypnea may be present
- Bradypnea may be present
- Kussmaul respirations may be present
Skin
- Erythema multiforme (target lesions) may be present
- Erythematous rash that blanches may be present
- Skin may be warm to the touch
- Sloughing of the skin may be present
- Blisters, pustules, and pus may be present
- Nikolsky's sign may be present (in toxic epidermal necrolysis)
- Petechiae may be present in conditions causing vasculitis
- Exanthema may be present , that appear as diffuse, fine macules and papules
- Urticaria
- Jaundice may be present in cases with liver involvement
Head
- There may be an area of localized redness in a contact dermatitis skin allergy
Eyes
- Conjunctivitis with redness and tearing of the eye may be seen
Throat
- Sore throat can be seen in Stevens-Johnson syndrome and toxic epidermal necrolysis.
- Angioedema may be seen
- Bronchospasm may be noted
Neck
- Lymphadenopathy may be present in DRESS syndrome (drug rash with eosinophilia and systemic symptoms syndrome)