Drug hypersensitivity reactions, skin

Adverse effects include hypersensitivity reactions (skin rashes, drug fever, rhinitis, conjunctivitis) salivary gland swelling iodism (metallic taste, burning mouth and throat, sore teeth and gums, symptoms of a head cold, and sometimes stomach upset and diarrhea) and gynecomastia. 

Growth factor potential The possibility that epoetin alfa can act as a growth factor for any tumor type, particularly myeloid malignancies, cannot be excluded. Hypersensitivity reactions Skin rashes and urticaria are rare, mild, and transient. If an anaphylactoid reaction occurs, immediately discontinue the drug and initiate appropriate therapy. Refer to Management of Acute Hypersensitivity Reactions. Fertility Impairment In female rats treated IV with epoetin alfa, there was a trend for slightly increased fetal wastage at doses of 100 and 500 units/kg. 

Dapsone (Avlosulfon) is a member of a class of chemical agents known as the sulfones. Dapsone is especially effective against M. leprae and is used with rifampin as the primary method of treating leprosy. Dapsone appears to exert its antibacterial effects in a manner similar to that of the sulfonamide drugs that is, dapsone impairs folic acid synthesis by competing with PABA in bacterial cells. Primary adverse effects associated with dapsone include peripheral motor weakness, hypersensitivity reactions (skin rashes, itching), fever, and blood dyscrasias, such as hemolytic anemia. 

Naisbitt DJ. Drug hypersensitivity reactions in skin understanding mechanisms and the development of diagnostic and predictive tests. Toxicology 2004 194 179-196. 

Brockow, K., 8c Romano, A (2008). Skin tests in the diagnosis of drug hypersensitivity reactions. Current Pharmaceutical Design, 14 (27), 2778-2791. 

Fig. 1 Methods to study delayed drug hypersensitivity reactions in humans, (a) T cells - mainly from the peripheral blood, but also from tissue sections (skin, kidney), proliferate when exposed to drugs in cell culture. The proliferating cells can be expanded and then cloned by limiting dilutions, and functional and phenotypic analysis performed to evaluate how drugs are stimulatory for T cells and which functions they perform, (b) Immunhistology of skin (and kidney) using antibodies to cell surface and cytokines, etc. the example shows that in a maculopapular exanthema both CD4+ and CD8+ T cells also express perforin...

The most common clinical picture of non-immediate RCM reactions is a macu-lopapular exanthema, which resembles other drug-induced T-cell-mediated hypersensitivity reactions. The reported onset of skin eruptions 2-10 days after the first exposure to a RCM and 1-2 days after re-exposure to the same substance is typical for an allergic drug reaction with a sensitization phase. 

Type IV Delayed-type Hypersensitivity (DTH). Delayed-type hypersensitivity reactions are T-cell mediated with no involvement of antibodies. However, these reactions are controlled through accessory cells, suppressor T cells, and monokine-secreting macrophages, which regulate the proliferation and differentiation of T cells. The most frequent form of DTH manifests itself as contact dermatitis. The drug or metabolite binds to a protein in the skin or the Langerhans cell membrane... 

Roychowdhury, S. and Svensson, C.K. (2005) Mechanisms of drug-induced delayed-type hypersensitivity reactions in the skin. AAPS Journal,... 

Type B effects are not related to the pharmacological properties of these drugs. Serious side effects may occur. Allergic skin and liver reactions to aspirin and paracetamol have been reported with risk of fibrosis, particularly in the retroperitoneal region for methysergide and hypersensitivity reactions with NSAID and pure analgesics. 

Mild to moderate side effects, including nausea, vomiting, abdominal pain, diarrhea, anorexia, and headache, occur in up to 33% of patients taking this drug. Skin rash and discoloration, fever, reversible male infertility, and liver enzyme elevation occur less frequently. Rare hematological abnormalities, such as agranulocytosis, aplastic anemia, hemolytic anemia, neutropenia, or other blood dyscrasias, can be fatal. Hypersensitivity reactions occur rarely. 

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