Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print TABLE A1–1: Classification of Allergic Drug Reactions Type Descriptor Characteristics Typical Onset Drug Causes I Immediate (IgE mediated) Allergen binds to IgE on basophils or mast cells, resulting in release of inflammatory mediators Within 1 hour (may be within 1–6 hours) Penicillin anaphylaxis, angioedema Blood products Polypeptide hormones Vaccines Dextran II Delayed; Cytotoxic Cell destruction occurs because of cell-associated antigen that initiates cytolysis by antigen-specific antibody (IgG) and complement. Most often involves blood elements. Typically >72 hours to weeks Penicillin, quinidine, quinine, heparin, thiouracils, sulfonamides, methyldopa III Delayed; Immune complex Antigen–antibody (IgG or IgM) complexes form and deposit on blood vessel walls and activate complement. Result is a serum sickness-like syndrome or vasculitis. >72 hours to weeks May be caused by penicillins, sulfonamides, minocycline, hydantoins IV Delayed; T Cell-mediated Antigens cause activation of T lymphocytes, which release cytokines and recruit effector cells >72 hours IVa Th1 cells and interferon-γ, monocytes and eosinophils respond to the antigen 1–21 days Tuberculin reaction, contact dermatitis IVb Th2 cells, interleukin-4 and interleukin-5 respond to the antigen 1–6 weeks Maculopapular rashes with eosinophilia IVc Cytotoxic T cells, perforin, granzyme B, FasL respond to the antigen 4–28 days Bullous exanthems; fixed drug eruptions IVd T cells and interleukin-8 respond to the antigen >72 hours Acute generalized exanthematous pustulosis ++ Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print TABLE A1–2: Top 10 Drugs and Agents Reported to Cause Skin Reactions Reactions per 1000 Recipients Amoxicillin 51.4 Trimethoprim–sulfamethoxazole 33.8 Ampicillin 33.2 Iopodate 27.8 Blood 21.6 Cephalosporins 21.1 Erythromycin 20.4 Dihydralazine hydrochloride 19.1 Penicillin G 18.5 Cyanocobalamin 17.9 Data from Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med 1994;331:1272-1285. ++ Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print TABLE A1–3: Treatment of Anaphylaxis Remove the inciting allergen, if possible. Assess airway, breathing, circulation, and orientation. Support the airway. Cardiopulmonary resuscitation: Start chest compressions (100/min) if cardiovascular arrest occurs at any time. Administer epinephrine 1:1000 (adults: 0.3–0.5 mg; children: 0.01 mg/kg) IM in the lateral aspect of the thigh. Place patient in recumbent position. Administer oxygen 8–10 L/min through facemask or up to 100% oxygen as needed; monitor by pulse oximetry, if available. Repeat IM epinephrine every 5–15 minutes for up to 3 injections if the patient is not responding. Establish IV line for venous access. Keep line open with 0.9% saline solution. For hypotension or failure to respond to epinephrine, administer 1–2 L at a rate of 5–10 mL/kg in the first 5–10 minutes. Children should receive up to 30 mL/kg in the first hour. Consider nebulized albuterol 2.5–5 mg in 3 mL of saline for lower airway obstruction; repeat as necessary. In cases of refractory bronchospasm or hypotension not responding to epinephrine because a β-adrenergic blocker is complicating management, glucagon 1–5 mg IV (20–30 mcg/kg; maximum, 1 mg in children) given IV over 5 minutes. Give epinephrine by ... GET ACCESS TO THIS RESOURCE Sign In Username Please enter User Name Password Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPharmacy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPharmacy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options Pop-up div Successfully Displayed This div only appears when the trigger link is hovered over. Otherwise it is hidden from view. Please Wait