Hypersensitivity syndrome

Gamboa P. Sanz ML. Caballero MR. Urrutia I. 43 Antepara I. Esparza R. De Week L The flow-cytometric determination of basophil activation induced by aspirin and other non-steroidal and anti-inflam- 44 matory drugs (NSAIDs) is useful for in vitro diagnosis of the NSAID hypersensitivity syndrome. Clin dS Exp Allergy 2004 34 1448-1457. 

Barbiturates, carbamazepine, and phenytoin (antiepileptic hypersensitivity syndrome)... 

The most frequent adverse effects are local reactions at the injection site (pain, tenderness, erythema, swelling, and pruritus), fevers (greater than 37.5°C or 99.5°F), headaches, dizziness, and irritability. Anaphylaxis and hypersensitivity reactions have been reported rarely and occur within a few hours after vaccine administration. In rare instances, a serum sickness-like apparent hypersensitivity syndrome (arthralgia, urticaria, ecchymoses, erythema multiforme, and erythema nodosum) has been... 

Arellano F, Sacristan JA. Allopurinol hypersensitivity syndrome A review. Ann Pharmacother 1993 27 337-343. 

The major side effects of allopurinol are skin rash, urticaria, leukopenia, GI problems, headache, and increased frequency of acute gouty attacks with the initiation of therapy. An allopurinol hypersensitivity syndrome characterized by fever, eosinophilia, dermatitis, vasculitis, and renal and hepatic dysfunction occurs rarely but is associated with a 20% mortality rate. 

It is important to remember that respiratory sensitization and asthma are related, but not identical, pathologies [31]. Asthma is a specific syndrome which appears to have genetic as well as environmental causes and there are numerous potential triggers which have been identified by immunotoxicologists [32], However, asthma is not the same disease as other respiratory hypersensitivity syndromes (sometimes referred to as chemical asthma, etc.) [33, 34], Various regulatory guidance documents have sought to deal with the latter disease entities to ensure that xenobiotics are assessed appropriately for their ability to induce immune-based pulmonary hypersensitivity reactions [35-37],... 

Chemical Sensitivity A Guide to Coping with Hypersensitivity Syndrome, Sick Building Syndrome and Other Environmental Illnesses. Bonnye L. Matthews. Jefferson, NC McFarland, 1992. 

Hypersensitivity reactions An apparent hypersensitivity syndrome has occurred. Refer to Management of Acute Hypersensitivity Reactions. 

Hypersensitivity reactions A potentially fatal apparent hypersensitivity syndrome has occurred with sulindac. 

Blood dycrasias There have been reports of blood dyscrasias that may or may not be associated with the hypersensitivity syndrome. 

Hypersensitivity Anaphylactoid purpura, anaphylaxis, angioneurotic edema, myocarditis, pericarditis, polyarthralgia, pulmonary infiltrates with eosinophilia, systemic lupus erythematous exacerbation, urticaria hypersensitivity syndrome (cutaneous reaction, eosinophilia, and one or more of the following Hepatitis, pneumonitis, nephritis, myocarditis, pericarditis, fever, lymphadenopathy). Muscuioskeietai - ArVr ra g a, arthritis, bone discoloration, joint stiffness and swelling, myalgia, polyarthralgia. 

Major limitations of the use of allopurinol are allergy, hypersensitivity syndromes, hepatotoxicity, bone marrow suppression, nonspecific central nervous system and gastrointestinal side effects. Skin rash occurs in 2% and Steven-Johnson syndrome, although rare, may occur. The latter can cause life-threatening major organ system failure. 

Creatine kinase activity should be measured in patients receiving potentially interacting drug combinations. In all patients, CK should be measured at baseline. If muscle pain, tenderness, or weakness appears, CK should be measured immediately and the drug discontinued if activity is elevated significantly over baseline. The myopathy usually reverses promptly upon cessation of therapy. If the association is unclear, the patient can be rechallenged under close surveillance. Myopathy in the absence of elevated CK has been reported. Rarely, hypersensitivity syndromes have been reported that include a lupus-like disorder and peripheral neuropathy. 

Allergic reactions manifesting as fever, urticaria or other rashes, and arthralgia occur in 1-5% of patients taking antithyroid drugs. There has been a report of thiamazole-induced hypersensitivity syndrome associated with reactivation of human herpes virus 6 and cytomegalovirus (57). 

Ozaki N, Miura Y, Sakakibara A, Oiso Y. A case of hypersensitivity syndrome induced by methimazole for Graves disease. Thyroid 2005 15(12) 1333-6. 

Rarely, hypersensitivity syndromes have been reported that include a lupus-like disorder and peripheral neuropathy. 

Hypersensitivity syndrome, defined as a drug-induced complex consisting of fever, rash, and internal organ involvement, has been associated with olanzapine (243). 

Rare multi-organ failure associated with Stevens Johnson syndrome, toxic epidermal necrolysis or drug hypersensitivity syndrome... 

Shear NH, Spielberg SP. Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk. J Clin Invest 1988 82 182 32. 

Opolon, R, Chosidow, O. Acute hepatitis during hypersensitivity syndrome due to midecamycin. Europ. J. Gastroenterol. Hepatol. 1997 9 1249-1250... 

Deficiency of epoxide hydrolase Phenytoin, carbamazepine, phenobarbital Life threatening hypersensitivity syndrome due to accumulation of toxic intermediates... 

Lupton GP, Odom RB. The allopurinol hypersensitivity syndrome. J Am Acad Dermatol 1979 l(4) 365-74. 

Suzuki Y, Inagi R, Aono T, Yamanishi K, Shiohara T. Human herpesvirus 6 infection as a risk factor for the development of severe drug-induced hypersensitivity syndrome. Arch Dermatol 1998 134(9) 1108-12. 

Vazquez-Mellado J, Guzman Vazquez S, Cazarin Barrientos J, Gomez Rios V, Burgos-Vargas R. Desensitisation to allopurinol after allopurinol hypersensitivity syndrome with renal involvement in gout. J Clin Rheumatol 2000 6 266-8. 

Within 5 days of being switched to valproate after developing a rash ascribed to carbamazepine, a 55-year-old man developed anticonvulsant hypersensitivity syndrome (maculopapular rash, fever, hepatitis, and eosinophilia) and ocular manifestations consistent with bilateral anterior uveitis (136). 

Although mild conjunctivitis is common in the anticonvulsant hypersensitivity syndrome, uveitis has not been reported before in this context. 

Schlienger RG, Shear NH. Antiepileptic drug hypersensitivity syndrome. Epilepsia 1998 39(Suppl 7) S3-7. 

Ciernik IF, Thiel M, Widmer U. Anterior uveitis and the anticonvulsant hypersensitivity syndrome. Arch Intern Med 1998 158(2) 192. 

Knowles SR, Shapiro LE, Shear NH. Anticonvulsant hypersensitivity syndrome incidence, prevention and management. Drug Saf 1999 21(6) 489-501. 

Pancreatitis due to azathioprine or mercaptopurine has usually been reported as part of the hypersensitivity syndrome (SEDA-16,520) (SEDA-20,341). It has mostly been observed in patients with inflammatory bowel disease, and required withdrawal of treatment in 1.3% of patients with Crohn s disease (3). Pancreatitis was not dose-related within the therapeutic range of doses and often recurred in patients who were rechallenged with either drug (SEDA-20, 341) (35). Fatal hemorrhagic pancreatitis occurred in one patient, but a role of concomitant drugs was also possible (SEDA-20, 341). Pancreatitis or hyperamylasemia were not significantly different in renal transplant patients randomly assigned to receive azathioprine or ciclosporin, and other causative factors were found in most patients with pancreatitis (36). 

Rashes or other aUergic-tjrpe cutaneous reactions are usually noted during the azathioprine hypersensitivity syndrome. Isolated but convincing reports point to the occurrence of vasculitis with microscopic polyarteritis (SEDA-21, 381) and Sweet s syndrome, which recurred after subsequent azathioprine exposure (SEDA-22, 410). 

Severe myalgia and symmetrical polyarthritis are sometimes reported in patients taking azathioprine. Eight cases of azathioprine-associated arthritis were identified in the WHO Drug Monitoring Database, including six cases with a typical hypersensitivity syndrome and two cases in whom joint involvement was the only reported symptom (40). Rhabdomyolysis has also been reported as a possible feature of the azathioprine hypersensitivity syndrome (SEDA-20, 341). 

A genetic predisposition is suspected, with a possible association between the hypersensitivity syndrome and the Bw4 and Bw6 phenotypes (SED-13, 1121). Mercaptopurine has sometimes been re-administered safely after a severe hypersensitivity reaction to azathioprine (49), suggesting a major role for the imidazole moiety of azathioprine. However, typical allergic reactions to mercaptopurine can also occur (SEDA-21, 381). 

Cascaval RI, Lancaster DJ. Hypersensitivity syndrome associated with azithromycin. Am J Med 2001 110(4) 330-1. 

A report of two cases has suggested that carbamazepine can cause colitis as part of the anticonvulsant hypersensitivity syndrome (48). 

The carbamazepine hypersensitivity syndrome has been reviewed (68). Some of the following cases are examples of the different manifestations of this syndrome. 

Eland lA, Dofferhoff AS, Vink R, Zondervan PE, Strieker BH. Cohtis may be part of the antiepileptic drug hypersensitivity syndrome. Epilepsia 1999 40(12) 1780-3. 

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