Urticaria drug-induced

Kurumaji Y, Shomo M. Drug-induced solar urticaria due to repirinast. Dermatology 1994 188(2) 117-21. 

The following are the most common causes of drug-induced urticaria antibiotics, notably penicillin (more following parenteral administration than by ingestion), barbiturates, captopril, levamisole, NSAIDs, quinine, rifampin, sulfonamides, thiopental, and vancomycin. 

Drug-induced cutaneous necrotizing vasculitis, a clinicopathologic process characterized by inflammation and necrosis of blood vessels, often presents with a variety of small, palpable purpuric lesions most frequently distributed over the lower extremities urticaria-like lesions, small ulcerations, and occasional hemorrhagic vesicles and pustules. The basic process involves an immunologically mediated response to antigens that result in vessel wall damage. 

If the patient received multiple drug therapy, the last dmg administered to the patient may have caused hypersensitivity and skin eruptions. Drug-induced dermatitis may take a few minutes, several hours, or a day for urticaria (hives) to appear. Certain drugs such as penicillin are known to cause hypersensitivity. 

The course of drug-induced urticaria is acute. In the vast majority of cases the lesions heal within 1-3 days without leaving any residual changes. However, the condition can assume a chronic form and the lesions can recur repeatedly over many weeks. Such events are most commonly observed in penicillin allergy. Small amounts of penicillins can be detected in foodstuffs, especially dairy products, in vaccines, secretions (saliva, semen), and furthermore they are produced by various molds (Hyphomycetes) which are found everywhere in our environment and hence gain entry to our bodies every day (Cole and Robinson 1961 McGovern et al. 1970 JiLLSON and Porter 1965 Stewart 1965 Un and Valu 1963), However, it is only in a small proportion of patients that the manifestations persist and it may be doubted whether the widespread occurrence of traces of penicillin is enough to explain why some cases of acute penicillin urticaria become chronic. 

This form of drug-induced urticaria is most commonly due to penicillin. The manifestations do not arise until at least 3-48 h after the dose of penicillin, and in some circumstances not until 3-4 days afterwards. Transitional forms between this condition and serum sickness are not uncommon clinically, the relationship is attested by the development of joint swellings. 

Goksel O, Aydin O, Misirligil Z, Demirel YS, Bavbek S. Safety of meloxicam in patients with aspirin/non-steroidal anti-inflammatory drug-induced urticaria and angioedema. J Dermatol 2010 37(11) 973-9. 

Examples of disease states Erythema urticaria angioedema respiratory symptoms GI symptoms anaphylaxis Drug-induced hemolytic anemia, thrombocytopenia, agranulocytosis (immune form) Serum sickness Drug-induced vasculitis Allergic contact dermatitis Psoriasis Maculopapular exanthema AGEP FDE DRESS SJS TEN EM... 

Immunologic Drug-induced urticaria, angioedema and anaphylaxis have been reported for use of diclofenac... 

Chaudhry T, Hissaria P, Wiese M, Heddle R, Kette F, Smith WB. Oral drug challenges in non-steroidal anti-inflammatory drug-induced urticaria, angioedema and anaphylaxis. IntemMed J June 2012 42(6) 665-71. 

The effect of intravenous vitamin C administration in the management of shingles has been evaluated in a 12-week prospective cohort study. Adverse effects were reported as not serious and included itching, burning sensation at the injection site followed by paraesthesia, and drug-induced urticaria [26 ]. 

Type III reactions (immune-complex reactions) In type III reactions, formation of an immune complex and its deposition on tissue surface serve as primary initiators. Occasionally, immune complexes bind to endothelial cells and lead to immune-complex deposition with subsequent complement activation in the linings of blood vessels. Circumstances that govern immune formation or immune-complex disease remain unclear to date, and it usually occurs without symptoms. The clinical symptoms of a type III reaction include serum sickness (e.g. 3-lactams), drug-induced lupus erythematosus (e.g. quinidine) and vasculitis (e.g. minocycline). Type III reactions can result in acute interstitial nephritis or serum sickness (fever, arthritis, enlarged lymph nodes, urticaria and maculopapular rashes) [1-3]. 

Aspirin and NSAIDs can induce allergic and pseudoallergic reactions. Because these drugs are used so widely, with much over-the-counter use, the health care professional must have a basic understanding of the types of reactions that can occur and how to prevent them. Three types of reactions occur bron-chospasm with rhinoconjunctivitis, urticaria/angioedema, and anaphylaxis. Remember that patients with gastric discomfort... 

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