Allergic drug reactions serum sickness

Allergic states Control of severe or incapacitating allergic conditions intractable to conventional treatment in serum sickness and drug hypersensitivity reactions. Parenteral therapy is indicated for urticarial transfusion reactions and acute noninfectious laryngeal edema (epinephrine is the drug of first choice). 

Adverse drug reactions can be classified simply according to their onset or severity. ADRs are occasionally classified as acute/ subacute/ or latent. Acute events are those observed within 60 minutes after the administration of a medication and include anaphylactic shock/ severe bronchoconstrictioii/ and nausea or vomiting (17). Subacute reactions occur within 1 to 24 hours and include maculopapular rasly serum sicknesS/ allergic vasculitiS/ and antibiotic-associated diarrhea or colitis. Latent reactions require 2 or more days to become apparent and include eczematous eruptions/ organ toxicity/ and tardive dyskinesia. 

Control of severe or incapacitating allergic conditions not controlled by other methods, bronchial asthma (including status asthmaticus), contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity reactions... 

The common side effects are nausea and vomiting. The others are allergic symptoms including drug fever, skin rash, urticaria, eosinophilia, photosensitization reactions, serum sickness like syndrome. Stevens-Johnson syndrome and exfoliative dermatitis are also common with longer acting agents. 

Most anaphylactoid reactions are due to a direct or chemical release of histamine, and other mediators, from mast cells and basophils. Immune-mediated hypersensitivity reactions have been classified as types I-IV. Type I, involving IgE or IgG antibodies, is the main mechanism involved in most anaphylactic or immediate hypersensitivity reactions to anaesthetic drugs. Type II, also known as antibody-dependent hypersensitivity or cytotoxic reactions are, for example, responsible for ABO-incompatible blood transfusion reactions. Type III, immune complex reactions, include classic serum sickness. Type IV, cellular responses mediated by sensitised lymphocytes, may account for as much as 80% of allergic reactions to local anaesthetic. 

Allergic reactions Angioneurotic edema, asthma, bee stings, contact dermatitis, drug reactions, allergic rhinitis, serum sickness, urticaria... 

General Indication Allergic disorders Principal Desired of Glucocorticoids Decreased inflammation Examples of Specific Disorders Anaphylactic reactions, drug-induced allergic reactions, severe hay fever, serum sickness... 

Allergic responses to drugs are mediated by the release of histamine or histamine-like substances, and they commonly present as skin rashes, particularly urticaria. More serious hypersensitivity responses include bronchospasm or the acute, explosive anaphylactic reaction with cyanosis and cardiovascular collapse. A delayed reaction known as serum sickness, although more often associated with such drugs as the penicillins and cephalosporins rather than with serum, manifests clinically 7 to 10 days after receiving the drug or serum as fever, malaise, joint pains, and urticarial skin rashes. 

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... 

This is the time between the last drug exposure and the appearance of the first symptoms, if the mechanism is considered to be allergic (Mayer 1933). Frequently there is a definite relationship between the reaction time and the type of clinical symptoms. This relationship was described by von Pirquet and Schick as early as 1905 with respect to anaphylactic shock and serum sickness due to foreign sera. 

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