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Allergy Frontiers: Diagnosis and Health Economics pp 403–422Cite as

Clinical Manifestations of Allergic Diseases: Drug Hypersensitivity

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Part of the book series: Allergy Frontiers ((ALLERGY,volume 4))

Drug allergies are those adverse drug reactions that are mediated by the specific immune system. Primary sensitization may involve T-cells alone or both T and B-cells with consecutive production of drug specific antibodies of different isotypes. It is mostly asymptomatic. However, there is evidence that primary sensitization may be induced not only by drug derived hapten-carrier-compounds, but also by cross-reactive allergens (e.g. viral infect, contact allergen etc.). Thus, an immune mechanism should also be considered in the case of reactions occurring on primary exposure to the causative drug.

The elicitation phase (or secondary response) can be divided into 4 categories corresponding to the type I–IV reactions described by Gell & Coombs. The vast majority of true drug allergies are thought to be either Ig-E (Type I) or T-lymphocyte-mediated (Type IV).

Drug allergy can cause a variety of diseases involving the skin, liver, kidney, lungs, and other organs. There is no single standardized diagnostic test that is able to confirm the immune mediated mechanism and identify the causative drug. Therefore, immune mediated drug hypersensitivity reactions and their causative drugs have to be recognized clinically by the constellation of exposure, timing, and pattern of organ manifestation. The diagnostic value of additional allergologic investigations is limited and their negative predictive value is not sufficient to exclude a drug allergy in the case of a suggestive history. Allergologic investigations comprise skin tests with immediate and late readings, the basophil activation test (BAT), and the lymphocyte transformation test (LTT). Provocation tests in order to identify the culprit drug are risky. The main target of allergologic investigations after a hypersensitivity reaction should be to enable doctors to prescribe further treatment with an appropriate risk/benefit ratio. Thus, such investigations may be reserved for finding an alternative drug therapy in situations where the incriminated drug(s) cannot easily be replaced.

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Authors and Affiliations

  1. Division of Allergology, Clinic for Rheumatology and Clinical Immunology/ Allergology, Inselspital, University of Bern, 3010-Bern, Switzerland

    Benno Schnyder & Werner J. Pichler

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  1. Benno Schnyder
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  2. Werner J. Pichler
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Editors and Affiliations

  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. Southampton General Hospital, University of Southampton, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. UMKC School of Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

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Schnyder, B., Pichler, W.J. (2009). Clinical Manifestations of Allergic Diseases: Drug Hypersensitivity. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Diagnosis and Health Economics. Allergy Frontiers, vol 4. Springer, Tokyo. https://doi.org/10.1007/978-4-431-98349-1_23

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  • DOI: https://doi.org/10.1007/978-4-431-98349-1_23

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