Approach to the patient with drug allergy

• Published in: The Medical clinics of North America Vol. 94; no. 4; p. 665
• Main Author: Schnyder, Benno
• Format: Journal Article
• Language: English
• Published: United States 01.07.2010
• Subjects: Adrenal Cortex Hormones - therapeutic use; beta-Lactams - adverse effects; Desensitization, Immunologic - methods; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Drug Hypersensitivity - immunology; Drug Hypersensitivity - therapy; Humans; Hypersensitivity, Delayed - chemically induced; Hypersensitivity, Delayed - diagnosis; Hypersensitivity, Delayed - immunology; Hypersensitivity, Delayed - therapy; Hypersensitivity, Immediate - chemically induced; Hypersensitivity, Immediate - diagnosis; Hypersensitivity, Immediate - immunology; Hypersensitivity, Immediate - therapy; Immunoglobulin E - immunology; Prescription Drugs - adverse effects; Risk Factors; Skin Tests; Sulfonamides - adverse effects
• ISSN: 1557-9859
• DOI: 10.1016/j.mcna.2010.03.006

Clinicians commonly encounter patients who report to have drug allergy. In a large part, such allergy corresponds to adverse drug reactions, which are not immune mediated. The incriminated drug need not always be avoided for further therapy. On the other hand, drug allergy may manifest in many unexpected clinical pictures and thus not be recognized. There is no single standardized diagnostic test to confirm the immune-mediated mechanism and to identify the causative drug. Therefore, immune-mediated drug hypersensitivity reactions and their causative drugs have to be considered by the constellation of exposure, timing, and clinical features, including the pattern of organ manifestation. Prior experience with the drug is also an important feature. An allergologic workup with additional investigation may provide some help. Patients should be informed carefully about their drug allergy, whereby symptoms, drug that elicits reaction, modes of diagnosis of drug allergy, and possibly alternatives should be indicated in their allergy passport.