Allergic drug reactions clinical presentation

The time interval from initiation of PPI therapy to clinical AIN is quite variable. In all cases published, symptoms are reported to occur anywhere from 1 week to 9 months after initial treatment with the PPI, with a mean time to clinical presentation of 9.9 weeks. Thus, chnicians must be mindful that AIN may occur over a wide time period following drug exposure. AKI that develops without an obvious cause should stimulate the chnician to consider the possibility of PPI-induced AIN if this class of medication is on the drug hst. Like many other drugs that cause allergic reactions or AIN, re-challenge with a PPI in a patient previously suspected of PPI-induced AIN causes rapid onset of symptoms of AIN [17, 28-30]. 

Drug-induced liver disease occurs as several different clinical presentations idiosyncratic reactions, allergic hepatitis, toxic hepatitis, chronic active toxic hepatitis, toxic cirrhosis, and liver vascular disorders. 

Allergic responses to drugs are mediated by the release of histamine or histamine-like substances, and they commonly present as skin rashes, particularly urticaria. More serious hypersensitivity responses include bronchospasm or the acute, explosive anaphylactic reaction with cyanosis and cardiovascular collapse. A delayed reaction known as serum sickness, although more often associated with such drugs as the penicillins and cephalosporins rather than with serum, manifests clinically 7 to 10 days after receiving the drug or serum as fever, malaise, joint pains, and urticarial skin rashes. 

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