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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Overview

Findings on physical examination will vary widely in drug allergy, depending on the specific manifestation of the type of drug allergy (SJS, TEN), 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 seen with drug rash with eosinophilia and systemic symptoms syndrome (DRESS)