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Drug Allergy: Causes, Symptoms and Treatment

A drug allergy is an immune system reaction to a medication. Symptoms range from mild skin rashes to life-threatening anaphylaxis and require prompt medical attention.

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Things worth knowing about "Drug Allergy"

A drug allergy is an immune system reaction to a medication. Symptoms range from mild skin rashes to life-threatening anaphylaxis and require prompt medical attention.

What is a Drug Allergy?

A drug allergy is an abnormal immune system response to a medication or one of its components. Unlike common side effects, which are dose-dependent, an allergic reaction is triggered by the immune system and can occur even with small amounts of the drug. Common culprits include antibiotics, pain relievers, contrast dyes used in imaging, and many other substances.

Causes

In a drug allergy, the immune system mistakenly identifies a medication as a harmful foreign substance. During first exposure, the immune system becomes sensitised. Upon re-exposure, it mounts an exaggerated response. Risk factors include:

Previous exposure to the medication
Genetic predisposition
Existing allergies or allergic asthma
Certain viral infections (e.g., Epstein-Barr virus)
Prolonged or repeated use of certain medications

Symptoms

Drug allergy symptoms can vary widely in severity, from mild to life-threatening. Common manifestations include:

Skin reactions: Hives (urticaria), redness, itching, rash
Mucosal swelling: Swelling of the lips, tongue, or throat
Respiratory symptoms: Shortness of breath, wheezing
Gastrointestinal symptoms: Nausea, vomiting, abdominal cramps
Anaphylaxis: A severe, life-threatening allergic reaction involving circulatory collapse

Rare but serious reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis represent medical emergencies requiring immediate treatment.

Diagnosis

Diagnosing a drug allergy requires careful evaluation by a physician or allergist. Common approaches include:

Medical history: Assessing the timeline between drug intake and symptom onset
Skin tests: Prick tests or intradermal tests to identify reactions to specific substances
Blood tests: Detection of specific IgE antibodies or immune cell activation markers
Drug provocation test: Controlled administration of the suspected drug under medical supervision (used in select cases only)

Treatment

The most important step in treating a drug allergy is the immediate discontinuation of the offending medication. Further treatment depends on the severity of the reaction:

Mild reactions: Antihistamines to relieve itching and rash; corticosteroids for more pronounced inflammation
Moderate reactions: Corticosteroids and close medical monitoring
Anaphylaxis: Immediate administration of epinephrine (adrenaline), corticosteroids, and antihistamines; emergency hospital care

Patients with a known severe drug allergy should always carry an allergy alert card and an epinephrine auto-injector. The triggering drug and chemically related substances should be avoided in the future.

Prevention and Guidance

Anyone with a drug allergy should inform all treating physicians and healthcare providers. In some cases, a drug desensitisation procedure may be performed when the medication is absolutely necessary. This is carried out exclusively under medical supervision in a specialised setting.

References

World Allergy Organization (WAO): Drug Allergy Guidelines. waojournal.org, 2021.
Brockow K. et al. - Drug Hypersensitivity Reactions. Allergo Journal International, 2022.
Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology: Drug Allergy: An Updated Practice Parameter. Annals of Allergy, Asthma and Immunology, 2010.

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