Adverse drug reactions hypersensitivity responses

Adverse drug reactions (ADRs) are considered the sixth leading cause of death in the United States and cost between 30 and 130 billion annually (White et al., 1999). Hypersensitivity reactions are thought to be responsible for about 6-10% of ADRs (Thong and Tan, 2011). Manifestations of drug hypersensitivity include contact hypersensitivity, respiratory hypersensitivity, systemic hypersensitivity, and autoimmunity. Pseudoallergy is also included in the category... 

Several types of adverse drug reactions do not easily fit into Cell and Coomb s classification scheme. These include most cutaneous hypersensitivity reactions (such as toxic epidermal necrolysis), immune-allergic hepatitis and hypersensitivity pneumonitis. Another difficulty is that allergic drug reactions can occur via more than one mechanism picryl chloride in mice induces both type 1 and type IV responses. Although other classification schemes have been proposed. Cell and Coomb s system remains the most widely utilized scheme [4-7]. 

In some drug reactions, several of these hypersensitivity responses may present simultaneously. Some adverse reactions to drugs may be mistakenly classified as allergic or immune when they are actually genetic deficiency states or are idiosyncratic and not mediated by immune mechanisms (eg, hemolysis due to primaquine in glucose-6-phosphate dehydrogenase deficiency, or aplastic anemia caused by chloramphenicol). 

The major adverse reactions to the penicillins are hypersensitivity responses. Manifestations of hypersensitivity inclnde nrticaria, angioedema, and anaphylaxis (type 1 reaction) hemolytic anemia (type 11 reaction) interstitial nephritis, vascnlitis, and serum sickness (type 111 reaction) and contact dermatitis or Stevens-Johnson syndrome (type IV reaction). A maculopapular rash occnrs late in the treatment course of 2% to 3% of patients receiving a penicillin drug. Once a patient has had a hypersensitivity response to a penicillin, it is probable, bnt not certain, that a reaction will occur with exposure to the same penicillin or to any other penicillin. Intradermal skin tests can predict whether a patient is at risk for developing a hypersensitivity reaction to the penicillins. If the resnlts are positive, penicillins should generally be avoided. 

Taxanes such as docetaxel and paclitaxel are mitotic inhibitors, disrupting microtubule function so adverse reactions, including hypersensitivity responses, to these drugs might be expected. 

Promoting an Optimal Response to Therapy Monitoring each patient for response to drug therapy and for the appearance of adverse reactions is an integral part of promoting an optimal response to therapy. The nurse immediately reports serious adverse reactions, such as signs and symptoms of a hypersensitivity reaction or superinfection, respiratory difficulty, or a marked drop in blood pressure... 

Adverse effects associated with ocular drugs are not imcommon, bnt serious reactions are extremely rare. These adverse reactions are nsnally manifestations of drug hypersensitivity (allergy) or toxicity. The allergic or toxic reaction usually occurs locally in the ocular tissues. Occasionally, as in erythema multiforme potentiated by sulfonamide agents, adverse reactions can manifest as a systemic response. 

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