Skip to main content

Advertisement

SpringerLink
Log in

Drug-Induced Anaphylaxis: Clinical Scope, Management, and Prevention

  • Anaphylaxis (M Sánchez-Borges, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion statement

Drug-induced anaphylaxis (DIA) is a severe, life-threatening reaction occurring after drug exposure. It is an important cause of anaphylaxis and accounts for up to one third of drug hypersensitivity reactions. As in other anaphylaxis reactions, immunoglobulin E (IgE) has an important role in its mechanism, but other non-immunological reactions may also occur in DIA. Cutaneous and respiratory symptoms are present in a majority of patients, and cardiovascular events are more common in elderly patients. A complete work up is recommended not just to offer safe alternatives, but also to avoid incorrect labeling of patients as allergic to drugs. The investigation includes in vitro tests when available, followed by skin prick and intradermal tests. Although provocation tests are still considered the “gold standard” for the diagnosis of drug allergy, in DIA, the risk versus benefit ratio must be analyzed. Non-steroid anti-inflammatory drugs and antibiotics are the drug classes more frequently involved. Neuromuscular blocking agents, chemotherapeutic drugs, and biologics are commonly related to reactions in a hospital setting. Prevention measures include an individualized education plan, with recommendations to avoid the culprit drug and potential cross-reactive medications. In selected patients, desensitization can induce a temporary state of tolerance. Protocols are available and can be adapted for drugs used in different situations, from cancer treatment to enzyme replacement therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, et al. International Consensus (ICON) on drug allergy. Allergy. 2014;69:420–37. This is the first consensus document in drug allergy with important tips in diagnosis and management.

    Article  CAS  PubMed  Google Scholar 

  2. Simons FER, Ardusso LR, Bilò MB, Cardona V, Ebisawa M, El-Gamal YM, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sole D, Ivancevich JC, Borges MS, Coelho MA, Rosario NA, Ardusso LRF, et al. Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA). Clinics. 2011;66(6):943–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jares EJ, Baena-Cagnani CE, Sánchez-Borges M, Ensina LF, Arias-Cruz A, Gómez M, et al. Drug-induced anaphylaxis in Latin American countries. J Allergy Clin Immunol Pract. 2015;3(5):780–8. This is a multicentric/multinational real-life study that highlights important issues in drug-induced anaphylaxis.

    Article  PubMed  Google Scholar 

  5. Worm M, Moneret-Vautrin A, Scherer K, Lang R, Fernandez-Rivas M, Cardona V, et al. First European data from the network of severe allergic reactions (NORA). Allergy. 2014;69(10):1397–404.

    Article  CAS  PubMed  Google Scholar 

  6. Jerschow E, Lin RY, Scaperotti MM, McGinn AP. Fatal anaphylaxis in the United States, 1999–2010: temporal patterns and demographic associations. J Allergy Clin Immunol. 2014;134(6):1318–28.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Farnam K, Chang C, Teuber S, Gershwin ME. Nonallergic drug hypersensitivity reactions. Int Arch Allergy Immunol. 2012;159(4):327–45.

    Article  CAS  PubMed  Google Scholar 

  8. Torres MJ, Barrionuevo E, Kowalski M, Blanca M. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Immunol Allergy Clin N Am. 2014;34(3):507–24–vii–viii.

  9. Brockow K, Sanchez-Borges M. Hypersensitivity to contrast media and dyes. Immunol Allergy Clin N Am. 2014;34(3):547–64.

    Article  Google Scholar 

  10. Faria E, Rodrigues Cernadas J, Gaspar A, Botelho C, Castro E, Lopes A, et al. Drug-induced anaphylaxis survey in Portuguese Allergy Departments. J Investig Allergol Clin Immunol. 2014;24(1):40–8.

    CAS  PubMed  Google Scholar 

  11. Aun MV, Blanca M, Garro LS, Ribeiro MR, Kalil J, Motta AA, et al. Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis. J Allergy Clin Immunol Pract. 2014;2(4):414–20.

    Article  PubMed  Google Scholar 

  12. Banerji A, Rudders S, Clark S, Wei W, Long AA, Camargo CA. Retrospective study of drug-induced anaphylaxis treated in the emergency department or hospital: patient characteristics, management, and 1-year follow-up. J Allergy Clin Immunol Pract. 2014;2(1):46–51. This study identifies areas for improvement in the management of drug-induced anaphylaxis.

    Article  PubMed  Google Scholar 

  13. Ensina LF, de Lacerda AE, de Andrade DM, Machado L, Camelo-Nunes I, Sole D. Drug-induced anaphylaxis in children: nonsteroidal anti-inflammatory drugs and drug provocation test. J Allergy Clin Immunol Pract. 2014;2(6):825.

    Article  PubMed  Google Scholar 

  14. Kuruvilla M, Khan DA. Anaphylaxis to drugs. Immunol Allergy Clin N Am. 2015;35(2):303–19.

    Article  Google Scholar 

  15. Simons FER, Ardusso LRF, Bilò MB, El-Gamal YM, Ledford DK, Ring J, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13–37.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Messaad D, Sahla H, Benahmed S, Godard P, Bousquet J, Demoly P. Drug provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann Intern Med. 2004;140(12):1001–6.

    Article  PubMed  Google Scholar 

  17. Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Drug allergy claims in children: from self-reporting to confirmed diagnosis. Clin Exp Allergy. 2008;38(1):191–8.

    CAS  PubMed  Google Scholar 

  18. Sterza T, Fernandes PH, Momoi C, Ensina LF, Nunes ICC, Sole D. Post exposition to etoricoxib in patients with negative oral drug provocation tests. World Allergy Organ J. 2015;8 Suppl 1:A186.

    Article  PubMed Central  Google Scholar 

  19. Baiardini I, Braido F, Fassio O, Calia R, Giorgio WC, Canonica GW, et al. Development and validation of the Drug Hypersensitivity Quality of Life Questionnaire. Ann Allergy Asthma Immunol. 2011;106(4):330–5.

    Article  PubMed  Google Scholar 

  20. Jares EJ, Sanchez-Borges M, Cardona-Villa R, Ensina LF, Arias-Cruz A, Gómez M, et al. Multinational experience with hypersensitivity drug reactions in Latin America. Ann Allergy Asthma Immunol. 2014;113(3):282–9.

    Article  PubMed  Google Scholar 

  21. Doña I, Blanca-López N, Torres MJ, García-Campos J, García-Núñez I, Gómez F, et al. Drug hypersensitivity reactions: response patterns, drug involved, and temporal variations in a large series of patients. J Investig Allergol Clin Immunol. 2012;22(5):363–71.

    PubMed  Google Scholar 

  22. Renaudin JM, Beaudouin E, Ponvert C, Demoly P, Moneret-Vautrin DA. Severe drug-induced anaphylaxis: analysis of 333 cases recorded by the Allergy Vigilance Network from 2002 to 2010. Allergy. 2013;68(7):929–37.

    Article  CAS  PubMed  Google Scholar 

  23. Aranda CS, Ensina LF, Nunes IC, Mallozi MC, Mendes C, Martins AM, et al. Diagnosis and management of infusion-related hypersensitivity reactions to enzyme replacement therapy for lysosomal diseases: the role of desensitization. J Allergy Clin Immunol Pract. 2016;4(2):354–6.

    Article  PubMed  Google Scholar 

  24. Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69:1026–45.

    Article  CAS  PubMed  Google Scholar 

  25. Chiriac AM, Demoly P. Drug allergy diagnosis. Immunol Allergy Clin N Am. 2014;34:461–71.

    Article  Google Scholar 

  26. Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, et al. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy. 2016;71:149–61.

    Article  CAS  PubMed  Google Scholar 

  27. Mangodt EA, Van Gasse AL, Decuyper I, Uyttebroek A, Faber MA, Sabato V, et al. In vitro diagnosis of immediate drug hypersensitivity: should we go with the flow. Int Arch Allergy Immunol. 2015;168(1):3–12.

    Article  CAS  PubMed  Google Scholar 

  28. Castells M. Anaphylaxis to chemotherapy and monoclonal antibodies. Immunol Allergy Clin N Am. 2015;35:335–48.

    Article  Google Scholar 

  29. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs—an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68:702–12.

    Article  CAS  PubMed  Google Scholar 

  30. Irani AM, Ak l. Management and prevention of anaphylaxis. F1000Res. 2015; 22:1-8.

  31. Sloane D, Govindarajulu U, Harrow-Mortelliti J, Barry W, Hsu FI, Hong D, Laidlaw T, Palis R, Legere H, Bunyavanich S, Breslow R, Wesemann D, Barrett N, Brennan P, Chong HJ, Liu A, Fernandez J, Fanning L, Kyin T, Cahill K, Bankova L, Lynch A, Berlin S, Campos S, Fuchs C, Mayer R, Matulonis U, Castells M. Safety, costs, and efficacy of rapid drug desensitizations to chemotherapy and monoclonal antibodies. J Allergy Clin Immunol Pract. 2016;16.S2213-2198(16)00011-8.

  32. Caiado J, Castells M. Presentation and diagnosis of hypersensitivity to platinum drugs. Curr Allergy Asthma Rep. 2015;15(4):15.

    Article  PubMed  Google Scholar 

  33. Scherer K, Brockow K, Aberer W, Gooi JH, Demoly P, Romano A, Schnyder B, Whitaker P, Cernadas JS, Bircher AJ; ENDA, the European Network on Drug Allergy and the EAACI Drug Allergy Interest Group. Desensitization in delayed drug hypersensitivity reactions—an EAACI position paper of the Drug Allergy Interest Group. Allergy. 2013;68(7):844

  34. Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, Campi P, Sanz ML, Castells M, Demoly P, Pichler WJ; European Network of Drug Allergy and the EAACI interest group on drug hypersensitivity. General considerations on rapid desensitization for drug hypersensitivity—a consensus statement. Allergy. 2010;65(11):1357-66.

  35. Otani IM, Banerji A. Immediate and delayed hypersensitivity reactions to proton pump inhibitors: evaluation and management. Curr Allergy Asthma Rep. 2016;16(3):17.

    Article  PubMed  Google Scholar 

  36. Ensina LF, Aranda CS, de Lacerda AE, Camelo-Nunes I, Sole D, Martins AM, et al. Laronidase hypersensitivity and desensitization in type I mucopolysaccharidosis: a case report. Pediatr Allergy Immunol. 2014;25(5):498–9.

    Article  PubMed  Google Scholar 

  37. Centers for Disease Control and Prevention Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition. 2015. Available: http://vaers.hhs.gov. Access 02/20/2016.

  38. Alicino C, Merlano C, Zappettini S, Schiaffino S, Della Luna G, Accardo C, et al. Routine surveillance of adverse events following immunization as an important tool to monitor vaccine safety. Hum Vaccin Immunother. 2015;11(1):91–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Federal University of São Paulo (UNIFESP), Rua dos Otonis, 725, São Paulo, 04025-002, Brazil

    Luis Felipe Ensina MD, MSc & Carolina Sanchez Aranda MD, MSc

  2. University of Santo Amaro (UNISA), R. Prof. Enéas de Siqueira Neto, 340, São Paulo, 04829-300, Brazil

    Luis Felipe Ensina MD, MSc

  3. University of the State of Rio de Janeiro (UERJ), Rua Angelo Agostini, 41, Rio de Janeiro, 20521-290, Brazil

    Mara Morelo Rocha Félix MD, MSc

Authors
  1. Luis Felipe Ensina MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mara Morelo Rocha Félix MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carolina Sanchez Aranda MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis Felipe Ensina MD, MSc.

Ethics declarations

Conflict of Interest

Dr. Mara Morelo Rocha Félix and Dr. Carolina Sanchez Aranda declare that they have no conflicts of interest.

Dr. Luis Felipe Ensina reports personal fees from MYLAN, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Anaphylaxis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ensina, L.F., Félix, M.M.R. & Aranda, C.S. Drug-Induced Anaphylaxis: Clinical Scope, Management, and Prevention. Curr Treat Options Allergy 3, 243–252 (2016). https://doi.org/10.1007/s40521-016-0085-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-016-0085-1

Keywords

Search

Navigation