Allergic reactions interstitial nephritis

All loop diuretics, with the exception of ethacrynic acid, are sulfonamides. Therefore, skin rash, eosinophilia, and less often, interstitial nephritis are occasional adverse effects of these drugs. This toxicity usually resolves rapidly after drug withdrawal. Allergic reactions are much less common with ethacrynic acid. 

The main varieties of adverse effects attributed to cimetidine relate to its antiandrogenic properties and its actions in sufficient concentrations on the central nervous system. There is also a spectrum of drug interactions, mainly attributable to inhibition of hepatic CYP isoforms, but they only have clinical consequences under special circumstances. Occasional adverse effects, which are generally minor, include bradycardia and conduction defects, thrombocytopenia, neutropenia, interstitial nephritis, mild hepatic dysfunction, and headache. Intestinal infection due to loss of the gastric acid barrier also occurs, and myalgia, fever, monoamine oxidase-Uke interactions, and neuropathies have been well documented occasionally. Allergic reactions, such as bronchospasm, have rarely been described. Anaphylaxis with recurrence on rechallenge is on record, as are asthma and skin effects. 

Efavirenz can cause an allergic syndrome called the DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms). It is a life-threatening reaction that typically includes a rash, fever, lymphadenopathy, hepatitis, interstitial nephritis, pneumonia, myocarditis, and hematological abnormalities, particularly eosinophi-lia and a mononucleosis-like atypical lymphocjdosis. The DRESS syndrome has been described in an HIV-infected woman taking efavirenz (20). 

Richmond JM, Whitworth JA, Eairley KE, Kincaid-Smith P. Co-trimoxazole nephrotoxicity. Lancet. 1979 Mar 3 1 (8114) 493. Kraemer MJ, Kendall R, Hickman RO, Haas JE, Bierman CW. A generalized allergic reaction with acute interstitial nephritis following trimethoprim-sulfamethoxazole use. Annals of allergy. 1982 Dec 49(6) 323-5. 

Kraemer MJ, Kendall R, Flickman RO, Flass JE, Bierman CW. A generalized allergic reaction with acute interstitial nephritis following trimethoprim-sulfamethoxazole use. Ann Allergy 1982 49 323-325. 

Adverse effects, in general, are low. However, all penicillins have the potential for causing interstitial nephritis (of allergic origin), and serious allergic reactions resulting in urticaria progressing to anaphylactic shock. 

The duration of most usual allergic reactions, such as urticarial and maculo-papular rashes, is limited to a few days, the exanthema seldom stays for more than 1-2 weeks. But lupus erythematosus syndrome, pancytopenia, interstitial nephritis and allergic pneumopathy (chronic interstitial) may be diseases lasting for months or years, leaving permanent damage even when treatment is possible. 

More severe allergic reactions to ampicillin reported lately include an anaphylactoid reaction immediately after opening an ampicillin bottle (25 ), an allergic pneumonitis (26 ) and a case of acute interstitial nephritis (27 ). 

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