Patch testing in cutaneous adverse drug reactions: Methodology, interpretation, and clinical relevance (original) (raw)

Adverse drug reactions: mechanisms and assessment

European surgical research, 2000

Adverse drug reactions (ADR) are an important clinical problem. They account for about 5% of all hospital admissions and cause death in approximately 0.01% of surgical patients. The mechanisms leading to ADR beyond IgE-mediated allergy are still poorly understood. The importance of chemically reactive drug metabolites and the involvement of T-lymphocytes in many drug hypersensitivity reactions have been highlighted in recent years. ADR are diagnosed on clinical grounds and the temporal relation between drug intake and the appearance of the symptoms. Allergy tests are required in the further assessment of the reaction. By means of skin tests, in vitro tests and provocation tests information about the culprit drug, the mechanism involved and possible alternatives can be obtained.

Adverse drug reactions: clinical assessment of drug induced disease

Journal of Ayub Medical College, Abbottabad : JAMC

Physicians are often confronted with patients who state that they are "allergic" to a drug. The goal of this review article is to help physicians to develop management plans for patients who present with drug induced diseases. It provides information that allows physicians to differentiate between reactions that are truly allergic in nature and those that are not immunologically mediated. The suggestions which may be helpful in the assessment are discussed and guidance is provided whether a drug may be safely readministered. Unfortunately until we are unable to thoroughly understand the mechanisms responsible for drug induced reactions, our management tools will remair limited.

Adverse Drug Reactions: Types and Treatment Options

rug hypersensitivity results from interactions between a pharmacologic agent and the human immune system. These types of reactions constitute only a small subset of all adverse drug reactions. Allergic reactions to medications represent a specific class of drug hypersen-sitivity reactions mediated by IgE. Immune-mediated drug reactions may be discussed gener-ally in the Gell and Coombs classification system, a widely accepted conceptual framework for understanding complex immune reactions. However, some reactions involve additional, poorly understood mechanisms that are not easily classified. Identifiable risk factors for drug hypersensitivity reactions include age, female gender, concurrent illnesses, and previous hypersensitivity to related drugs. Drug hypersensitivity is a clinical diagnosis based on avail-able data. Laboratory testing may be useful, with skin testing providing the greatest speci-ficity. Treatment is largely supportive and includes discontinuation of the offending medica-tion, symptomatic treatment, and patient education. Patients with penicillin allergy should avoid carbapenems, and caution should be used in prescribing cephalosporins in these patients. Reactions to radiocontrast media can be limited by pretreatment with prednisone, diphenhydramine, and either ephedrine or a histamine H2-receptor antagonist. (Am Fam Physician 2003;68:1781-90. Copyright© 2003 American Academy of Family Physicians.)

Cutaneous Adverse Drug Reactions: How to Identify the Trigger

Actas Dermo-Sifiliográficas, 2018

It is estimated that 10% to 15% of medicated patients develop adverse drug reactions (ADR). Despite the high prevalence of ADR, the identification of the trigger drugs remains a medical challenge, mainly in polymedicated patients. Our goal is to update the diagnostic tools to identify enhancer drugs of type B-ADR that compromise the skin and/or mucous membranes, in order to optimize patients' follow-up and improve their quality of life. We develop the review in two stages: I-we review the pathophysiological mechanisms of the ADR; II-we developed the clinical approach for the identification of the triggering drug.

Understanding Adverse Drug Reactions and Drug Allergies: Principles, Diagnosis and Treatment Aspects

Recent Patents on Inflammation & Allergy Drug Discovery, 2008

Adverse Drug Reactions (ADRs) and drug allergies-as a subset of ADRs-make a significant public health concern, complicating 5 to 15% of therapeutic drug courses. They may result in diminished quality of life, increased physician visits, health care costs, hospitalizations, and even death. The incidence of serious ADRs in hospitalized patients was estimated to be 6.7% and for fatal ADRs to be 0.32%, so recognizing and taking action on ADRs is an important aspect of medication management. Allergic reactions to drugs refer to those ADRs that involve immune mechanisms which account up to 15% of ADRs and can be identified as being a type I through IV immune reaction that the most common immunologic mechanism is IgE-mediated-type I reaction. Clinical manifestations of allergic reactions range from pruritus and rash to serious reactions such as systemic anaphylaxis and cardiovascular emergencies and they are responsible for 2-3% of hospitalized patients.

cutaneous adverse drug reactions-re l e v a n t aspects to diagnosis and treatment-Part II *

2004

Severe cutaneous adverse drug reactions generally require hospitalization, sometimes in intensive care or burns units, for observation of the vital signs and the visceral function. The objective was to describe these reac tions in order to facilitate recognition and treatment. This group of drug reactions includes drug hypersensitivity syndrome (DHS), acute generalized exanthematous pustulosis (AGEP), anticoagulant-induced skin necrosis, smallvessel vasculitis (SVV), propylthiouracil hypersensitivity vasculitis and serum sickness disease. DHS has been most relevant due to universal prescription of aromatic anticonvulsant drugs and dapsone use in the treatment of some diseases such as acne and leprosy. AGEP is mostly induced by b-lactam related drugs and presents similar clinical characteristics as generalized pustular psoriasis, thus these must be differentiated. SVV can present an occult sys temic illness, with impairment of relevant internal organs, such as kidneys, lungs and hema...

Adverse Drug Reactions: An Overview

Drug is single active chemical entity present in a medicine that is used for diagnosis, prevention and treatment of diseases. Adverse drug reaction is unexpected effect of drug on animal and human being and considered as one of causes of morbidity and mortality of hospitalized patients. Although many drug reactions are preventable such as those associated with prescription errors while others are not preventable. The adverse drug reactions are often not discovered until after the drug has been marketed. The occurrence of ADR can be explain on basis of the drug's pharmacology and show apparent dose-response relationship in susceptible animal and human being. Adverse drug reactions caused by immune and non-immune mechanisms are a major cause of morbidity and mortality worldwide. They are the most common iatrogenic illness, complicating 5% to 15% of therapeutic drug courses. Adverse drug reactions can be divided schematically into two major categories: type A and type B. Type A reactions are common, predictable and may occur in any individual. Type B ADRs are uncommon and unpredictable and only occur in susceptible individuals. A critical factor in the drug response such as in ADRs could be the inter-patient differences in plasma concentrations arising from the same drug regimen. Pharmacogenomics is likely to be particularly useful for drugs that have variable kinetics and dynamics, and narrow therapeutic index. Management strategies employed for the ADRs is categorized as drug withdrawal, dose reduction, additional treatment for ADR, and no change in regimen with no additional treatment. Managing these cases should be done immediately after their appearance and those individuals or animals with the problem should be carefully handled with the appropriate medical expertise. Better approaches must be devised for reporting and assessing ADR. In addition, pharmaceutical companies should strive to reduce the adverse effect of a drug. INTRODUCTION Drug is single active chemical entity present in a medicine that is use for diagnosis, prevention and treatment of diseases. (Mererjone, 2003). The person-to-person variability of drug response is a major problem in clinical practice and drug development (Meyer, 2000). It can lead to therapeutic failure or adverse effects of drugs (ADRs) in individuals or subpopulations of patients. Adverse drug reaction is unexpected effect of drug on animal and human being and considered as one of causes of morbidity and mortality of hospitalized patients (Ditto, 2004). A productive hospital-based reporting program can be instrumental in providing valuable information regarding potential problems of drug usage in an institution. Through these efforts, problems are identified and resolved, which results in continuous improvement inpatient Care (Murphy and Frigo, 1993). Spontaneous reporting program, a common method of drug surveillance is capable of recognizing ADRs in the daily medical practice even though under reporting and absence of information on number of people actually exposed to the drug are its disadvantages (Alvarez-Requejo et al., 1998). Although many drug reactions are preventable such as those associated with prescription errors while others are not preventable. The adverse drug reactions are often not discovered until after the drug has been marketed. Pharmaceutical companies strive to work out the adverse effect profile of a drug before it is marketed, but because the complete range of adverse effects is not known, therefore, most severe drug induced reactions cannot be elucidated before licensing, therefore efficient post marketing surveillance is needed. However, even if improved surveillance is carried out the problem will not be resolved. As more drugs are marketed and as more individuals take multiple drugs, the occurrence of adverse drug reactions will probably continue to increase. Adverse drug reaction are still considered as problem of drug therapy in association with considerable morbidity, mortality, decrease compliance and therapeutic success as well as high direct and indirect medical cost (Tripathis,2003). There for the objectives of this seminar paper are: to high light the causality, clinical manifestation and management of ADR, and to recommend further study in the area of ADR.