Drug allergy causes

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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], Jolanta Marszalek, M.D. [3]

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
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	Abatacept, Abciximab, Acebutolol, Acetazolamide, Acyclovir, Adalimumab, Adapalene, Adenosine, Albuterol, Alendronate, Aliskiren, Allopurinol, Alteplase, Amifostine, Amiloride, Aminocaproic acid, Amiodarone, Amlodipine, Anastrozole, Antihemophilic factor, Anti-inhibitor coagulant complex, Antithrombin III, Argatroban, Aripiprazole, Atazanavir, Atenolol, Atomoxetine, Atorvastatin calcium, Barbiturates, Benazepril, Bendamustine, Benoxaprofen, Betaxolol, Bevacizumab, Bisoprolol, Brentuximab vedotin, Brimonidine, Brinzolamide, Budesonide And Formoterol Fumarate Dihydrate, Bumetanide, Buprenorphine Hydrochloride, Naloxone Hydrochloride, Cabergoline, Captopril, Carbamazepine, Carteolol, Carvedilol, Cefdinir, Celecoxib, Cephalosporins, Cetuximab, Chlorambucil, Chlormezanone, Chlorothiazide, Chlorthalidone, Cholestyramine, Cilostazol, Ciprofloxacin and Dexamethasone, Citalopram Hydrobromide, Clindamycin, Clonidine, Clopidogrel, Coagulation factor VIIa, Codeine, Colestipol, Conivaptan, Dabigatran, Dalteparin, Daptomycin, Darbepoetin Alfa, Darifenacin, Dasatinib, Denosumab, Desirudin, Desvenlafaxine, Dexlansoprazole, Dexmethylphenidate, Diazoxide, Diclofenac, Diclofenamide, Dofetilide, Digoxin, Digoxin immune fab, Diltiazem, Donepezil, Dipyridamole, Disopyramide, Dobutamine, Dorzolamide, Doxycycline Hyclate, Dronedarone, Duloxetine, Dutasteride, Efavirenz, Emtricitabine, and Tenofovir disoproxil fumarate, Enalapril maleate, Enoxaparin, Epoetin alfa, Eprosartan, Eptifibatide, Erlotinib, Esmolol, Esomeprazole, Eszopiclone, Etanercept, Etonogestrel and Ethinyl Estradiol Vaginal Ring, Ethacrynic acid, Ethotoin, Etravirine, Everolimus, Exenatide, Ezetimibe, Ezetimibe And Simvastatin, Factor IX complex, Felodipine, Fenofibrate, Fenoldopam, Filgrastim, Flecainide, Fluticasone, Fluticasone and Salmeterol, Fluvastatin, Fosamprenavir, Fosinopril, Gold, HPV Vaccine, Ibandronic acid, Ibritumomab tiuxetan, Interferon beta-1b, Ipilimumab, Insulin, Insulin glulisine, Interferon beta-1a, Ipratropium Bromide And Albuterol, Irbesartan, Isoniazid, Lamotrigine, Leflunomide, Lenalidomide, Levonorgestrel and Ethinyl estradiol, Mesalamine, Methyldopa, Methylphenidate, Moxifloxacin, Nebivolol, Nevirapine, NSAIDs, Oxycodone, Pemetrexed, Penicillamine, Pentosan polysulfate, Phenacetin, Phenobarbitol, Phenylbutazone, Phenytoin, Pioglitazone, Primidone, Procainamide, Quinidine, Risedronate, Rosiglitazone, Rosuvastatin, Sorafenib, Streptomycin, Sulfacetamide sodium And Prednisolone acetate, Sulfasalazine, Sulfonamide, Sulfonylurea, Suramin, Terbinafine, Tetracycline, Thiabendazole, Thioacetazone, Tolterodine, Valsartan, Vancomycin, Vandetanib, Zolpidem, 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

Causes by Specific Allergic Reactions^[1]^[2]

Cutaneous reactions	Clinical features	Implicated medications
Exanthems	▸ Delayed-type hypersensitivity ▸ Evolve over days after drug initiation ▸ Diffuse macules and papules	Allopurinol, Amlodipine, amphotericin, barbiturates, captopril, carbamazepine, cephalosporins, chloramphenicol, Digoxin, 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	Abatacept, ACE inhibitors, Acyclovir, Adalimumab, Albuterol, Alendronate, Aliskiren, Alteplase, Aminosalicylic acid, Amlodipine, Anastrozole, Anticonvulsants, Antihemophilic factor, Anti-inhibitor coagulant complex, Antithrombin III, Aripiprazole, Aspirin, Atomoxetine, Atropine, Benazepril, Budesonide And Formoterol Fumarate Dihydrate, Captopril, Carvedilol, Celecoxib, cephalosporins, Cetuximab, Cholestyramine, Clonidine, Clopidogrel, Colestipol, Darbepoetin Alfa, Darifenacin, Darunavir, Dasatinib, Denosumab, desvenlafaxine, Dexlansoprazole, Dexmethylphenidate, Dextran, Digoxin immune fab, Dofetilide, Donepezil, Dutasteride, Enalapril maleate, Enoxaparin, Epoetin alfa, Esomeprazole, Eszopiclone, Everolimus, Exenatide, Ezetimibe, Factor IX complex, Heparin, Hydralazine, Ipratropium Bromide And Albuterol, Felodipine, Filgrastim, Fluticasone, Fosinopril, Interferon beta-1a, Ipratropium bromide, Irbesartan, Isradipine, Levonorgestrel and Ethinyl estradiol, Levothyroxine, Liraglutide, Lisinopril, Losartan, Metolazone, Monoclonal antibodies, Moexipril hydrochloride, Moxifloxacin, Nisoldipine, NSAIDs, Olmesartan, Omalizumab, Opioids, Oxycodone, Pegfilgrastim, Penicillins, Pentamidine, Pentoxifylline, Perindopril, Pitavastatin, Procainamide, Quinine, Quinidine sulfate, Ramipril, Ranolazine, Risedronate, Rosuvastatin, Sitagliptin, Sulfonamides, Tenofovir, Tetracyclines, Thiouracil, Ticlopidine, Tolterodine, Tubocurarine, Ustekinumab, Valsartan, Vancomycin, Vardenafil, Zolpidem
Fixed drug eruption	▸ Hyperpigmented plaques that recur at same skin or mucosal site	ACE inhibitors, adalimumab, allopurinol, amlodipine, aspirin, barbiturates, benzodiazepines, carbamazepine, cephalosporins, clindamycin, co-trimoxazole, dextromethorphan, diltiazem, fluconazole, lamotrigine, lansoprazole, metronidazole, NSAIDs, paclitaxel, paracetamol, penicillin, phenolphthalein, omeprazole, quinine, salicylates, sulfonamides, terbinafine, tetracyclines, trimethoprim
Pustules	▸ Acute generalized eczematous pustulosis or acneiform rash	antibiotics, calcium-channel blockers, corticosteroids, sirolimus,Fluticasone,Erlotinib
Bullous	▸ Flaccid or tense blisters	Argatroban, Bendamustine, Captopril, Dasatinib, Erlotinib, penicillamine, furosemide, Risedronate, 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, Acetazolamide, Acyclovir, Alendronate, Atazanavir, Barbiturates, Bendamustine, Β-lactam antibiotics, Brinzolamide, Carbamazepine, Carvedilol, Celecoxib, Chlorpropamide, Co-trimoxazole, Darunavir, Dorzolamide, Duloxetine, efavirenz, emtricitabine, and tenofovir disoproxil fumarate, Erlotinib, Escitalopram, Fenofibrate, Gold, H2 Antagonists, Histamine, Indapamide, Lamotrigine, Leflunomide, Macrolides, Metolazone, Mefloquine, Mexiletine, Minoxidil, Moxifloxacin, NSAIDS, Olmesartan medoxomil-Hydrochlorothiazide, Phenothiazines, Phenytoin, Rifampicin, Rivaroxaban, Simvastatin, Sitagliptin, Spironolactone, sulfacetamide sodium and prednisolone acetate, Sulfonamides, Tadalafil, Tetracyclines, Thiazides, Ticlopidine
Toxic epidermal necrolysis (TEN)	▸ Similar to SJS but >30% epidermal detachment	Acetazolamide, Acyclovir, Alendronate, Allopurinol, Atazanavir, Barbiturates, Bendamustine, Brinzolamide, Carbamazepine, Celecoxib, Dorzolamide, Erlotinib, Escitalopram, Gold, Griseofulvin, Indapamide, Lamotrigine, Leflunomide, Metolazone, Moxifloxacin, Nitrofurantoin, NSAIDs, Olmesartan Medoxomil-Hydrochlorothiazide, Penicillins, Phenytoin, Salicylates, Sitagliptin, Spironolactone, Sulfacetamide sodium And Prednisolone acetate, sulfonamides, tetracyclines

Organ-specific reactions	Clinical features	Implicated medications
Pulmonary	▸ Pulmonary fibrosis, hypersensitivity pneumonitis	Nitrofurantoin, bleomycin, Cabergoline, Cetuximab, Desvenlafaxine, Dronedarone, Erlotinib, Hydrochlorothiazide, Methyclothiazide, Methotrexate, Amiodarone, Moxifloxacin
Hepatic	▸ Hepatitis, cholestasis	Acetazolamide, Para-aminosalicylic acid, Brinzolamide, Dorzolamide, Sulfacetamide sodium And Prednisolone acetate, sulfonamides, phenothiazines
Renal	▸ Interstitial nephritis, membranous glomerulonephritis	Penicillin, sulfonamides, gold, penicillamine, allopurinol
Hematologic	▸ Hemolytic anemia, thrombocytopenia, granulocytopenia	▸ Hemolytic anemia — 5-Azacytidine, Acetophenazine, Aclarubicin, Actinomycin D, Albendazole, Alemtuzumab, Aminopyrine, Amitriptyline, Amodiaquine, Anakinra, Antipyrine, Azathioprine, Bevacizumab, Bortezomib, Captopril, Carbimazole, Caspofungin, Chloramphenicol, Chlorpromazine, Cidofovir, Cilazapril, Clofarabine, Clozapine, Deferiprone, Desipramine, Docetaxel, Dothiepin, Doxorubicin, Eflornithine, Ethosuximide, Erlotinib, Ethotoin, Flucytosine, Fludarabine, Ganciclovir, Gemcitabine, Gold salts, Hydroxycarbamide, Hypersplenism, Ibritumomab tiuxetan, Idarubicin, Imatinib mesylate, Interferon alpha, Interferon beta, Irinotecan, Isoniazid, Levomepromazine, Mercaptopurine, Methimazole, Mirtazapine, Mitoxantrone, Nortriptyline, Paclitaxel, Penicillamine, Pentamidine, Pentostatin, Perazine, Phenylbutazone, Phenytoin, Pipothiazine, Procainamide, Propylthiouracil, Pyrimethamine, Quinidine, Remoxipride, Riluzole, Stiripentol, Sulfasalazine, Sulphonamides, Ticlopidine, Topotecan, Trastuzumab, Trimetrexate, Valganciclovir, Zidovudine, Zileuton ▸ Thrombocytopenia — Abciximab, Aldesleukin, Amobarbital, Amrinone, Capreomycin, Carboplatin, Cefotaxime, Cefotetan, Cefoxitin, Ceftizoxime, Chloramphenicol, Chlorpropamide, Cinoxacin, Claforan, Diabinese, Digoxin, Disopyramide, Enoxaparin, Eptifibatide, Erlotinib, Estrogens, Ethanol, Exna, Heparin, Paraplatin, Phenylbutazone, Procainamide, Proleukin, Secobarbital, Sulfonamides, Thiazides, Tuinal ▸ Granulocytopenia — Acetazolamide, Aripiprazole, Benzthiazide, Bortezomib, Brinzolamide, Bumetanide, Capecitabine, Captopril, Ceftazidime, Celecoxib, Chlorpropamide, Dapsone, Diabinese, Disopyramide, Dorzolamide, Enalapril maleate, Exna, Fosinopril, Fortaz, Penicillin, quinine, salicylate, Sulfacetamide sodium And Prednisolone acetate, sulfonamides

Multiorgan reactions	Clinical features	Implicated medications
Anaphylaxis	▸ Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension	Abatacept, Abciximab, Acebutolol, Acetazolamide, Albuterol, Aliskiren, Alteplase, Aminocaproic acid, Anastrozole, Antihemophilic factor, Anti-inhibitor coagulant complex, Aripiprazole, Atomoxetine, β-lactam antibiotics, Betaxolol, Bisoprolol, Bivalirudin, Bortezomib, Buprenorphine Hydrochloride, Naloxone Hydrochloride, monoclonal antibodies, adalimumab, Benazepril, Bendamustine, Captopril, Carteolol, Carvedilol, Celecoxib, Ciprofloxacin and Dexamethasone, Clopidogrel, Dabigatran, Dalteparin, Daptomycin, Darbepoetin Alfa, Denosumab, Desirudin, Dexlansoprazole, Dexmethylphenidate, Digoxin, Digoxin immune fab, Dobutamine, Enalapril maleate, Enoxaparin, epoetin alfa, Esmolol, Esomeprazole, Eszopiclone, Etanercept, Everolimus, Exenatide, Ezetimibe, Factor IX complex, Fenoldopam, Fluticasone, Heparin, HPV Vaccine, Ibandronic acid, Infliximab, Insulin glargine, Insulin glulisine, Insulin lispro, Interferon beta-1a, Interferon beta-1b, Ipratropium Bromide And Albuterol, Labetalol, Lepirudin, Levonorgestrel and Ethinyl estradiol, Moxifloxacin, Nadolol, Nebivolol, Olmesartan, Omalizumab, Penbutolol, Pindolol, Propranolol, Protamine, Rituximab, Rivaroxaban, Solifenacin, Tinzaparin, Trastuzumab, Triamterene, Urokinase, Zolpidem
Systemic lupus erythematosus	▸ Arthralgia, myalgias, fever, malaise	Hydralazine, procainamide, isoniazid, propafenone, Levonorgestrel and Ethinyl estradiol
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, Adalimumab, Amiodarone, Cefdinir, Methyldopa, Amoxapine, Moxifloxacin, Fluticasone, Acyclovir, Allopurinol, Amlodipine, Bortezomib, Captopril, Captopril and Hydrochlorothiazide, Chlorothiazide, Chlorthalidone, Clopidogrel, Delavirdine, Enalapril maleate, Filgrastim, Fosinopril, Furosemide, Hydrochlorothiazide,,Imatinib, Lisinopril, Lisinopril/Hydrochlorothiazide, Losartan, Lovastatin, Methyclothiazide, Metolazone, Pravastatin, Prazosin, Ramipril, Abatacept, Spironolactone, Spironolactone/Hydrochlorothiazide, Ticlopidine, Valsartan, Colchicine, Quinidine, Quinidine gluconate, Dronedarone, Enoxaparin, Thiazide, Fluticasone/salmeterol, Infliximab, Sitagliptin, Enalaprilat, Fluoxetine, Hydrochloride, Hydroflumethiazide, Polythiazide, Valaciclovir, Simvastatin, Methylphenidate, Dexlansoprazole, Sumatriptan, Bisoprolol, Rituximab, Aggrenox, Penicillin G, Norfloxacin, Isoniazid, Penicillin G procaine, Famciclovir, Cefuroxime, Rifampin isoniazid, Rifampin, Interferon alfa-2a, Amoxicillin-clavulanate potassium, Interferon alfa-2a, Pegylated interferon alfa-2a, vancomycin, Atovaquone proguanil, Terbinafine, Indinavir, Ciprofloxacin Hydrochloride, Lamivudine zidovudine, Interferon alfa-2b, Gemifloxacin mesylate, Pentamidine Isethionate, Abacavir lamivudine zidovudine, Nitrofurantoin, Zidovudine, Quinine Sulfate, Valproic acid, Divalproex, Niacin/Simvastatin, Ezetimibe/Simvastatin, Felodipine, Fosinopril/Hydrochlorothiazide, Moexipril/Hydrochlorothiazide, Quinapril/Hydrochlorothiazide, Enalapril maleate/Hydrochlorothiazide, Enalapril/Felodipine, Perindopril ,Fluvastatin, Diltiazem, Metoprolol succinate and hydrochlorothiazide, Nebivolol, Amiodarone, Olmesartan Medoxomil-Hydrochlorothiazide, Amlodipine Besylate, Divalproex, Pioglitazone/Glimepiride, Aspirin/Dipyridamole
Serum sickness	▸ Urticaria, arthralgia, fever	Heterologous antibodies, infliximab, Cefdinir, Bupropion, Levothyroxine, Tetracycline hydrochloride, Antivenom, Glatiramer acetate, Antivenin,,Measles, Ticlopidine, Clopidogrel, Novobiocin, Epinephrine, Omalizumab, Rituximab, Immunosuppressive drug, Digoxin, Levothyroxine, Ciprofloxacin, Cefprozil, Cefaclor, Oxacillin, Amoxicillin, Penicillin G benzathine, Ampicillin, Ceftibuten, Cefpodoxime, Terbinafine, Gemifloxacin, Metronidazole, Cefadroxil, Doxycycline, Levofloxacin, Minocycline, Moxifloxacin, Sulfadiazine, Lincomycin, Sulfamethoxazole
Drug reaction with eosinophilia and systemic symptoms (DRESS)	▸ Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy	Allopurinol, anticonvulsants, atazanavir, minocycline, sulfonamides, spironolactone

References

↑ Khan, David A. (2010-02). "Drug allergy". The Journal of Allergy and Clinical Immunology. 125 (2 Suppl 2): –126-137. doi:10.1016/j.jaci.2009.10.028. ISSN 1097-6825. PMID 20176256. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
↑ Lee, Anne (2006). Adverse drug reactions. London Chicago: Pharmaceutical Press. ISBN 0853696012.

[1] Khan, David A. (2010-02). "Drug allergy". The Journal of Allergy and Clinical Immunology. 125 (2 Suppl 2): –126-137. doi:10.1016/j.jaci.2009.10.028. ISSN 1097-6825. PMID 20176256. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)

[2] Lee, Anne (2006). Adverse drug reactions. London Chicago: Pharmaceutical Press. ISBN 0853696012.

[1]

[2]