Drug allergy causes

Drug Allergy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

Overview

The types of drugs that can cause drug allergies vary. Drugs containing sulfa are common in causing drug allergy reactions. Other common drugs implicated in leading to an allergic reaction are antibiotics, insulin, and iodinated drugs.

Causes

Common Causes

When a medication causes an allergic reaction, it is called an allergen. The following is a short list of the most common drug allergens

• Antibiotics
  • Penicillin
  • Sulfa drugs
  • Tetracycline
• Analgesics
  • Codeine
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
• Anticonvulsives
  • Dilantin
  • Tegretol

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Effect	Abciximab, Acetazolamide, Allopurinol, Amifostine, Barbiturates, Benazepril, Bendamustine,Benoxaprofen, Betaxolol, Bisoprolol, Brentuximab vedotin, Brinzolamide, Budesonide And Formoterol Fumarate Dihydrate, Bumetanide, Buprenorphine Hydrochloride, Naloxone Hydrochloride, Cabergoline, Captopril, Carbamazepine, Carteolol, Carvedilol, Cefdinir, Celecoxib, Cephalosporins, Chlorambucil, Chlormezanone, Chlorothiazide, Chlorthalidone, Clindamycin, Codeine, Diclofenac, Diltiazem, Erlotinib, Ethotoin, Etravirine, Exenatide, Fosamprenavir, Gold, Ibandronic acid, Ibritumomab tiuxetan, Interferon beta-1b, Ipilimumab, Insulin, Isoniazid, Lamotrigine, Leflunomide, Lenalidomide, Methyldopa, Methylphenidate, Nebivolol, Nevirapine, NSAIDs, Penicillamine, Phenacetin, Phenobarbitol, Phenylbutazone, Phenytoin, Primidone, Procainamide, Quinidine, Sorafenib, Streptomycin, Sulfacetamide sodium And Prednisolone acetate, Sulfasalazine, Sulfonamide, Sulfonylurea, Suramin, Terbinafine, Tetracycline, Thiabendazole, Thioacetazone, Vancomycin, Vandetanib, Zonisamide
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Acetazolamide
• Allopurinol
• Amifostine
• Barbiturates
• Benoxaprofen
• Brentuximab vedotin
• Carbamazepine
• Cephalosporins
• Chlorambucil
• Chlormezanone
• Clindamycin
• Codeine
• Diclofenac
• Diltiazem
• Erlotinib
• Ethotoin
• Etravirine

• Fosamprenavir
• Gold
• Ibritumomab tiuxetan
• Ipilimumab
• Insulin
• Isoniazid
• Lamotrigine
• Leflunomide
• Lenalidomide
• Methyldopa
• Methylphenidate
• Nevirapine
• NSAIDs
• Penicillamine
• Phenacetin
• Phenobarbitol
• Phenylbutazone

• Phenytoin
• Primidone
• Procainamide
• Quinidine
• Sorafenib
• Streptomycin
• Sulfasalazine
• Sulfonamide
• Sulfonylurea
• Suramin
• Terbinafine
• Tetracycline
• Thiabendazole
• Thioacetazone
• Vancomycin
• Vandetanib
• Zonisamide

Causes by Specific Allergic Reactions

Cutaneous reactions	Clnical features	Implicated medications
Exanthems	Delayed-type hypersensitivity Evolve over days after drug initiation Diffuse macules and papules	Allopurinol, amphotericin, barbiturates, captopril, carbamazepine, cephalosporins, chloramphenicol, erythromycin, furosemide, gentamicin, gold salts, lithium, nalidixic acid, nitrofurantoin, penicillins, phenothiazines, phenylbutazone, phenytoin, sulfonamides), thiazides
Urticaria/ angioedema	Often IgE mediated Onset within minutes of drug initiation	ACE inhibitors, aminosalicylic acid, anticonvulsants, aspirin, atropine, cephalosporins, dextran, hydralazine, monoclonal antibodies, NSAIDs, opioids, penicillins, pentamidine, quinine, sulfonamides, tetracyclines, thiouracil, tubocurarine, vancomycin
Fixed drug eruption	Hyperpigmented plaques that recur at same skin or mucosal site	ACE inhibitors, allopurinol, amlodipine, aspirin, barbiturates, benzodiazepines, carbamazepine, cephalosporins, clindamycin, co-trimoxazole, dextromethorphan, diltiazem, fluconazole, lamotrigine, lansoprazole, metronidazole, NSAIDs, paclitaxel, paracetamol, penicillin, phenolphthaleinomeprazole, quinine, salicylates, sulfonamides, terbinafine, tetracyclines, trimethoprim
Pustules	Acute generalized eczematous pustulosis (AGEP) Acneiform	AGEP: antibiotics, calcium-channel blockers Acneiform: corticosteroids, sirolimus
Bullous	Flaccid blisters Tense blisters	Flaccid blisters: captopril, penicillamine Tense blisters: furosemide, vancomycin
Cutaneous lupus erythematosus	Erythematous/scaly plaques in photodistribution	Hydrochlorothiazide, calcium-channel blockers, ACEIs
Stevens-Johnson syndrome (SJS)	Purpuric macules on face and trunk with <10% epidermal detachment, fever, stomatitis, ocular involvement	antibiotics, barbiturates, β-lactam antibiotics, carbamazepine, chlorpropamide, co-trimoxazole, gold, H2 blocker, histamine, lamotrigine, leflunomide, macrolides, mefloquine, NSAIDs, phenothiazines, phenytoin, rifampicin, sulfonamides, tetracyclines, thiazides
Toxic epidermal necrolysis (TEN)	Similar to SJS but >30% epidermal detachment	Allopurinol, barbiturates, carbamazepine, gold, griseofulvin, lamotrigine, leflunomide, nitrofurantoin, NSAIDs, penicillins, phenytoin, salicylates, sulfonamides, tetracyclines

Organ-specific reactions	Clnical features	Implicated medications
Pulmonary	Pulmonary fibrosis, hypersensitivity pneumonitis	Nitrofurantoin, bleomycin, methotrexate
Hepatic	Hepatitis, cholestasis	Para-aminosalicylic acid, sulfonamides, phenothiazines
Renal	Interstitial nephritis, membranous glomerulonephritis	Penicillin, sulfonamides, gold, penicillamine, allopurinol
Hematologic	Hemolytic anemia, thrombocytopenia, granulocytopenia	Penicillin, quinine, sulfonamides

Multiorgan reactions	Clnical features	Implicated medications
Anaphylaxis	Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension	β-lactam antibiotics, monoclonal antibodies
Systemic lupus erythematosus	Arthralgia, myalgias, fever, malaise	Hydralazine, procainamide, isoniazid
Vasculitis	Cutaneous or visceral vasculitis	Allopurinol, aspirin, β-lactam antibiotics, carbamazepine, carbimazole, co-trimoxazole, diltiazem, erythromycin, furosemide, gold, G-CSF, GM-CSF, hydralazine, interferons, methotrexate, minocycline, NSAIDs, penicillamine, propylthiouracil, retinoids, sulfasalazine, sulfonamides, thiazides, thrombolytics
Serum sickness	Urticaria, arthralgia, fever	Heterologous antibodies, infliximab
Drug reaction with eosinophilia and systemic symptoms (DRESS)	Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy	Anticonvulsants, sulfonamides, minocycline, allopurinol