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

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.

Neck

• Lymphadenopathy may be seen with drug rash with eosinophilia and systemic symptoms syndrome (DRESS)