Allergic drug reactions respiratory

Contact allergy to glucocorticoids is not rare in patients with atopic dermatitis. In patients with known contact allergy to budesonide, allergic skin reactions can also occur when inhaled forms of the drug are used, as shown by a randomized, double-bhnd, placebo-controlled study in 15 non-asthmatic patients with budesonide hypersensitivity on patch testing (101). In four of seven patients who used inhaled budesonide, there was reactivation of the 6-week-old patch test sites and they had new distant skin lesions. No flare-up reactions were observed in the other 11 patients (three had used inhaled budesonide and eight placebo for 1 week). None of the patients developed respiratory symptoms spirometry and peak expiratory flow rates remained normal. 

The manufacturers received 1100 reports of allergic reactions in the first 2 years after launch. Fatal anaphylactic and anaphylactoid reactions have been reported 10% of all reports on anaphylactic reactions in the USA named zomepirac, making it second only to the much older drug tolmetin. Hypersensitivity reactions are characterized by hypotension, bronchospasm, and serious respiratory distress, with or without oropharyngeal edema. Type-Ill allergic reactions have also been described. 

It is well documented that certain viral infections are associated with the induction and/or exacerbation of allergic reactions [84-86]. Moreover, infection with HCV, HAV and HBV can be associated with increased IgE levels [30, 31] and certain allergic manifestations [28]. In addition, HIV-1 infection can be associated with increased IgE levels [33-42] and augmented prevalence of adverse reactions to drugs and urticarial rash [47-48], Similarly, certain bacterial infections (e.g. S. aureus) can exacerbate atopic dermatitis [62-64], certain forms of allergic rhinitis [65, 66], and asthma [87], Therefore, it appears that viral and bacterial infections can be involved in the induction and/or exacerbation of respiratory and skin allergies. 

---