Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++Table Graphic Jump LocationTABLE A4-1Classification of Allergic Drug ReactionsView Table||Download (.pdf) TABLE A4-1 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 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, 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 LocationTABLE A4-2Top 10 Drugs and Agents Reported to Cause Skin ReactionsView Table||Download (.pdf) TABLE A4-2 Top 10 Drugs and Agents Reported to Cause Skin Reactions Drug Name 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 Penicillin G 18.5 Cyanocobalamin 17.9 Source: Data from Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331:1272–1285. ++Table Graphic Jump LocationTABLE A4-3Treatment of AnaphylaxisView Table||Download (.pdf) TABLE A4-3 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 the patient in a 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 ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth