Dear Friends DRUG HYPERSENSITIVITY is a challenging subject and I felt an update in our day to day practice it refers to unpredictable reactions leading to reproducible symptoms or signs initiated by exposure to a drug at a dose normally tolerated by non-hypersensitive persons. This may either be IgE mediated  (immediate) or non–IgE mediated (delayed) hypersensitivity reactions RISK FACTORS FOR DRUG ALLERGY DRUG FACTORS Nature of the drug Degree of exposure (dose, duration, frequency) Route of administration Cross-sensitization HOST FACTORS Age and Sex Genetic factors (HLA type, Acetylator status) Concurrent medical illness (e.g. Ebstein-Barr Virus (EBV), human immunodeficiency virus (HIV), asthma) Previous drug reaction Multiple allergy syndrome LIST OF DRUGS FREQUENTLY IMPLICATED IN ALLERGIC DRUG REACTIONS Aspirin (other analgesics-antipyretics) Penicillins and cephalosporins Sulfonamides Antituberculous drugs Nitrofurans Antimalarials Griseofulvin Sedative-hypnotics Anticonvulsants Anesthetics (local and general) Phenolphthalein Antipsychotic tranquilizers Antihypertensive agents (hydralazine) Antiarrhythmia agents (quinidine, procainamide) Iodinated contrast media Antisera and vaccines Organ extracts (ACTH, insulin) Heavy metals (gold) Allopurinol Penicillamine Antithyroid drugs DIAGNOSIS The diagnosis of drug allergy is based on a detailed history of the onset of symptoms & sign combined with a relationship between the appearance of those symptoms and drug use.The clinical diagnosis is followed by carefully selected diagnostic tests depending on whether the reaction is IgE or non-IgE mediated. TREATMENT Apart from immediate cessation of the putative drug, the following measures should also be taken: ACUTE IMMEDIATE MANAGEMENT OF IgE MEDIATED REACTIONS…… NON SERIOUS REACTIONS : antihistamines SERIOUS REACTIONS (anaphylaxis) emergency management, including securing the airway; maintaining breathing and circulation; DRUGS.. Intramuscular epinephrine 0.3 mL of a 1:1,000 concentration up to every 5 minutes in adults or 0.01 mg/kg in children up to a maximum dose of 0.3 mg Intramuscular promethazine Intravenous fluids Systemic corticosteroids may be used to prevent the delayed-phase reaction in acute anaphylaxis and to prevent/treat associated angioedema and lower airway inflammation. IMMEDIATE MANAGEMENT OF Non–IgE MEDIATED REACTION NON SERIOUS REACTIONS : antihistamines SERIOUS REACTIONS… STEVENS JOHNSON SYNDROME : The use of tapered doses of systemic corticosteroids is not uniformly practiced by all specialists in drug allergy.Oropharyngeal hygiene and gargle solutions, as well as eye care should be ensured. TOXIC EPIDERMAL NECROLYSIS… Skin care, eye care (sterile eye management, topical corticosteroids), adequate hydration and nutrition and respiratory care are paramount. High-dose intravenous immunoglobulin (IVIG 1 g/kg/d for 2 days) has been used at various centers with generally good outcomes, especially in improving skin re-epithelialization. However, the evidence remains controversial, and the original hypothesis on the anti-apoptotic effect of IVIG now does not appear to be so. Other immunosuppressive therapies, including cyclophosphamide, plasmapharesis and systemic corticosteroids, have not been found to be uniformly useful. Recent interest has re-emerged on the possible benefits of cyclosporin in these patients. DRUG INDUCED HYPERSENSITIVE SYNDROME The use of tapered doses of systemic corticosteroids is not uniformly practiced by all specialists in drug allergy.         DRUG DESENSITIZATION.. Desensitization is a process in which the drug to which the patient is allergic is administered   to the patient in small incremental doses to induce a state of temporary tolerance to the drug. This should only be attempted if the offending drug is deemed essential and no alternatives are available. I hope the above update will be HELPFUL… Thanks Dr K N Poddar

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Every time you are posting clinically useful, and day today commonly facing problems and their solutions. Today you posted very important topic of drug hypersensitivity which is challenging to doctors every time when we face it because of it's severity and life threatening issue. Thanks for sharing the wonderful post Dr Poddar, sir

Thanks Dr Devi for your valuable comments and appreciation
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Necrotizing dermatitis iatrogenic.. Steven Johnson syndrome..

Very nice & informative.

Thanks Dr Giridhar
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nice information

Thanks Dr Khalil
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Nice information.

Thanks Dr Ashok
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Thanks for sharing useful information

Thanks Dr Sharma
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Very informative and useful update sir

Very nice & informative.

very nice and useful thanks

Thanks Dr Ansari
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Very nice & useful information sir

Thanks Dr patil
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