Drug allergy, anaphylaxis

A thorough drug allergy history should be taken to discern true allergy (anaphylaxis) from adverse event (stomach upset). 

Davido, A., Hallali, P. and Boutchnei, T. (1989) Shock caused by glafenine. Apropos of 7 complications. Revue de Medecine Interne, 10, 113-117. van der Klauw, M.M., Wilson, J.H. and Strieker, B.H. (1996) Drug-associated anaphylaxis 20 years of reporting in The Netherlands (1974-1994) and review of the literature. Clinical and Experimental Allergy, 26, 1355-1363. 

Hypersensitivity reactions (ranging from rash, urticaria, and fever to anaphylaxis) occur in fewer than 5% of patients, most commonly in patients with a history of drug allergies, especially to penicillins. 

Basophils and Eosinophils. These two types of granulocyte represent only a small proportion of the circulating leukocytes. The basophil possesses receptors specific for the Fc portion of IgE molecules. It is involved in allergic reactions and can play a role in the clinical state of anaphylaxis, which is a life-threatening allergic response. Eosinophils are involved with the immune reactivity of drug allergies and with the body s immune response to parasitic infestations such as worms (see chapter 9). 

Chiu AM, Kelly KJ Anaphylaxis Drug allergy, insect stings, and latex. Immunol Allergy Clin North Am 2005 25 389. [PMID 15878462]... 

Anaphylaxis can occur in response to any allergen. Common causes include insect bites, food allergies (peanuts, brazil and hazelnuts are the most common) and drug allergies. Pollens and other inhaled allergens rarely cause anaphylaxis. 

Examples Allergic rhinitis, asthma, systemic anaphylaxis Some drug allergies (eg.. penicillin) Serum sickness, Arthus reaction Tuberculin reaction, contact dermatitis (with IVc) Chronic asthma, chronic allergic rhinitis Maculopapular exanthema with eosinophilia Contact dermatitis, Maculopapular and bullous exanthema, hepatitis AQEP Beh t disease... 

Van der Klann, N.M., Wilson, J.H.P, and Strieker, B.H., Drug assisted anaphylaxis 20 years reporting in the southern lands, Elim. Erop. Allergy, 1996, 26 1355-1363. 

Hadji L, Benveniste J (1980) Experimental cardiac anaphylaxis to an anaesthetic adjuvant as a model for drug allergy. Allergol Immunopathol (Madr) 8 485-486 Jerums G, Whittingham S, Wilson P (1967) Anaphylaxis to suxamethonium. A case report. Br J Anaesth 39 73-77... 

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