Drug allergy physical examination

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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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.

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
• The pulse may be bounding
• The pulse may be alternating in strength (pulsus alternans)
• A paradoxical pulse may be present

Symmetry

• The pulses may be asymmetric

Blood Pressure

• Hypotension may be present
• Hypertension may be present
• A wide pulse pressure may be present
• A narrow pulse pressure may be present

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)