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Drug Hypersensitivity

  • Eric MacyEmail author
Chapter

Abstract

Drug hypersensitivity is a special class of adverse drug reactions mediated through the effects drug have, directly or indirectly, on mast cells and/or the immune system in response to specific drugs acting as antigens. Drug hypersensitivity can be clinically grouped in four general categories: acute-onset benign reactions (IgE-mediated, IgG and complement-mediated, or direct mast cell activation), anaphylaxis (IgE-mediated, IgG and/or complement-mediated, or direct mast cell activation), delayed-onset benign reactions (T-cell-mediated or IgG or IgM and complement-mediated) and delayed serious systemic reactions including delayed-onset serious cutaneous adverse reactions (SCARs), such as drug eruption with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), (T-cell-mediated) and immune-mediated hepatitis, nephritis, cytopenias, or other organ system involvement.

The management of drug hypersensitivity during pregnancy is very much like the management of drug hypersensitivity in any patient. Whenever possible, medication avoidance is preferred during pregnancy. However, if a lifesaving medication is needed during pregnancy that has been associated with a hypersensitivity reaction, many pregnant patients can still be safely tested for tolerance and, if confirmed acutely hypersensitive, treated via desensitization. All drug hypersensitivities that can be managed by desensitization involve mast cell activation. Most clinically significant T-cell-mediated hypersensitivity requires complete avoidance as desensitization is not possible for T-cell-mediated reactions. Needless avoidance of essential medications, such as penicillin in the setting of GBS colonization or a syphilis infection, can cause increased morbidity.

Keywords

Anaphylaxis Challenge Desensitization Drug allergy Drug allergy testing Hypersensitivity Penicillin Pregnancy Peripartum Serious cutaneous adverse drug reaction 

Abbreviations

Cdiff

Clostridium difficile

DRESS

Drug eruption with eosinophilia and systemic symptoms

EHR

Electronic health record

GBS

Group B Streptococcus

MCM

Major congenital malformation

MRSA

Methicillin-resistant Staphylococcus aureus

SCARs

Serious cutaneous adverse reactions

SJS

Stevens-Johnson syndrome

Tdap

Tetanus diphtheria acellular pertussis

TEN

Toxic epidermal necrolysis

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of AllergyKaiser PermanenteSan DiegoUSA

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