Drug allergy differential diagnosis: Difference between revisions
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{{CMG}} {{AE}} {{CP}} | {{CMG}} {{AE}} {{CP}} | ||
{{Drug allergy}} | {{Drug allergy}} | ||
==Overview== | ==Overview== | ||
True drug allergy needs to be differentiated from other reactions caused by [[drugs]], such as pseudoallergic reactions and drug induced [[autoimmune]] like reactions. Drug allergy also needs to be differentiated from other conditions and reactions that present similarly to drug allergy. | True drug allergy needs to be differentiated from other reactions caused by [[drugs]], such as pseudoallergic reactions and drug induced [[autoimmune]] like reactions. Drug allergy also needs to be differentiated from other conditions and reactions that present similarly to drug allergy. | ||
==Differentiating Drug Allergy from Other | ==Differentiating Drug Allergy from Other Diseases== | ||
===Pseudoallergic Reactions=== | ===Pseudoallergic Reactions=== | ||
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*[[NSAIDS]] | *[[NSAIDS]] | ||
*[[ | *[[Vancomycin]] | ||
*[[ | *[[Local anesthetics]] | ||
*[[ | *[[Radiocontrast agents]] | ||
*[[ | *[[Opiates]] | ||
*[[ | *[[Chemotherapeutics]] | ||
*[[ | *[[Monoclonal antibodies]] and other biologic therapies used in [[cancer]] treatment | ||
===Auto-immune Like Syndromes Caused by Drugs=== | ===Auto-immune Like Syndromes Caused by Drugs=== | ||
[[Lupus]] like syndromes can be caused by the following medications; | [[Lupus]] like syndromes can be caused by the following medications; | ||
*[[ | *[[Penicillamine]] | ||
*[[ | *[[Procainamide]] | ||
*[[ | *[[Phenytoin]] | ||
*[[ | *[[Isoniazid]] | ||
*[[ | *[[Sulfasalazine]] | ||
*[[ | *[[Amiodarone]] | ||
*[[ | *[[Minocycline]] | ||
A pemphigus like syndrome can be caused by [[penicillamine]] | A pemphigus like syndrome can be caused by [[penicillamine]] | ||
IgA bullous dermatitis can be caused by: | IgA bullous dermatitis can be caused by: | ||
*[[ | *[[Vancomycin]] | ||
*[[ | *[[Ceftriaxone]] | ||
*[[ | *[[Ciprofloxacin]] | ||
*[[ | *[[Metronidazole]] | ||
==Differentiating IgE Mediated and Non-IgE Mediated Drug Allergy from Other Conditions== | ==Differentiating IgE Mediated and Non-IgE Mediated Drug Allergy from Other Conditions== | ||
===IgE Mediated Drug Allergies=== | ===IgE Mediated Drug Allergies=== | ||
Certain [[IgE]] mediated conditions need to be differentiated from IgE mediated drug allergies ([[angioedema]], [[urticaria]], [[anaphylaxis]], bronschospasm) <ref name="pmid22165859">{{cite journal |author=Warrington R, Silviu-Dan F |title=Drug allergy |journal=Allergy Asthma Clin Immunol |volume=7 Suppl 1 |issue= |pages=S10 |year=2011 |pmid=22165859 |pmc=3245433 |doi=10.1186/1710-1492-7-S1-S10 |url=}}</ref>; | Certain [[IgE]] mediated conditions need to be differentiated from IgE mediated drug allergies ([[angioedema]], [[urticaria]], [[anaphylaxis]], bronschospasm) <ref name="pmid22165859">{{cite journal |author=Warrington R, Silviu-Dan F |title=Drug allergy |journal=Allergy Asthma Clin Immunol |volume=7 Suppl 1 |issue= |pages=S10 |year=2011 |pmid=22165859 |pmc=3245433 |doi=10.1186/1710-1492-7-S1-S10 |url=}}</ref>; | ||
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*[[Mastocytosis]] | *[[Mastocytosis]] | ||
*[[Infection]] ([[EBV]], gastrointestinal [[parasites]], [[hepatitis A]], [[hepatitis B]], and [[hepatitis C]] | *[[Infection]] ([[EBV]], gastrointestinal [[parasites]], [[hepatitis A]], [[hepatitis B]], and [[hepatitis C]] | ||
===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]]). | ||
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* [[Streptococcal]] infection | * [[Streptococcal]] infection | ||
*[[Viral infection]] | *[[Viral infection]] | ||
==References== | |||
{{reflist|2}} | |||
[[Category:Allergology]] | |||
[[Category:Immunology]] | |||
[[Category:Emergency medicine]] | |||
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Revision as of 21:48, 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
True drug allergy needs to be differentiated from other reactions caused by drugs, such as pseudoallergic reactions and drug induced autoimmune like reactions. Drug allergy also needs to be differentiated from other conditions and reactions that present similarly to drug allergy.
Differentiating Drug Allergy from Other Diseases
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;
- NSAIDS
- Vancomycin
- Local anesthetics
- Radiocontrast agents
- Opiates
- Chemotherapeutics
- Monoclonal antibodies and other biologic therapies used in cancer treatment
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 IgE Mediated and Non-IgE Mediated 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) [1];
- Insect bites and stings
- Carcinoid syndrome
- Asthma
- Food allergy
- Latex allergy
- Scombroid fish poisoning
- Mastocytosis
- Infection (EBV, gastrointestinal parasites, hepatitis A, hepatitis B, and hepatitis C
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).
- Kawasaki disease
- Still's disease
- Acute graft-versus-host disease
- Psoriasis
- Insect bites/ stings
- Streptococcal infection
- Viral infection
References
- ↑ Warrington R, Silviu-Dan F (2011). "Drug allergy". Allergy Asthma Clin Immunol. 7 Suppl 1: S10. doi:10.1186/1710-1492-7-S1-S10. PMC 3245433. PMID 22165859.