Time Pattern of Allergic Reactions to Drugs

Hoigné, R; Jaeger,; Wymann, R.; Egli, Andreas; Müller, Ulrich; Heß, T; Galeazzi, R; Maibach, R; Up, Künzi

doi:10.1007/978-3-0348-7292-8_5

Cited by 9 publications

(9 citation statements)

References 5 publications

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“…The reaction time in relation to the main types of skin reactions has been reported previously (3). In urticaria, it was generally of the acute or subacute type, whereas in most cases of maculopapular exanthema it was of the subacute type.…”

Section: Resultsmentioning

confidence: 68%

See 1 more Smart Citation

Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20‐year survey

Hunziker

Künzi²,

Braunschweig

et al. 1997

Allergy

Self Cite

193

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Studies on the epidemiology of common adverse cutaneous drug reactions have rarely been reported, since they can only be successfully conducted in clinics of internal medicine employing consultant dermatologists and having a comprehensive or intensive system of monitoring. Between 1974 and 1993, the adverse skin reactions occurring in divisions of general internal medicine of three different hospitals were monitored by a computerized comprehensive system. The "drug-monitoring patient" was defined as the recipient of at least one drug during hospitalization. The relationship of the skin reactions to drug causality in these patients had to be either definite (proven by re-exposure) or probable (drug relation greater than that of nondrug causality). The skin reactions were classified into four diagnostic groups. Maculopapular exanthema, urticaria, and vasculitis were the three main groups. The fourth group comprised cases of nonhomogeneous but clinically well-defined special exanthema. For selected drugs and years of observation, special emphasis was placed on the study of time patterns (reaction time, exposure time). A total of 1317 definite or probable drug-induced skin reactions occurred during the hospitalization of 48,005 consecutively admitted "drug-monitoring patients": 1201 cases of maculopapular exanthema, 78 cases of urticaria, 18 cases of cutaneous vasculitis, and 20 cases of special exanthema (five of erythema multiforme minor, six of fixed eruption, one of photosensitivity reaction, and eight of acneiform eruption). The main drugs involved did not differ for the three main types of skin reactions, penicillins ranking in the first place, followed by sulfonamides--most often combined with trimethoprim--and in the third place nonsteroidal anti-inflammatory drugs. The reaction time (time from last drug exposure to first skin manifestation) for urticaria showed a relevant proportion of the acute type (within 1 h) and most of the subacute type (1-24 h). For maculopapular exanthema, the subacute or, rarely, the latent type (1-8 days, exceptionally more than 8 days) predominated. For aminopenicillins, the rate of occurrence of skin reactions increased with increasing exposure time up to 12 days, and then markedly diminished. Possibly due to the tendency to withdraw suspected drugs even in the case of minor (e.g., maculopapular) skin reactions, no severe events such as erythema multiforme major/Stevens-Johnson syndrome or toxic epidermal necrolysis occurred.

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Section: Resultsmentioning

confidence: 68%

“…As a rule, no particular investigations were performed unless considered of practical relevance to the individual patient. In spite of differing opinions in the literature, all cases of maculopapular exanthema were attributed to the allergic/pseudoallergic mechanism (3,6,7).…”

Section: Methodsmentioning

confidence: 99%

Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20‐year survey

Hunziker

Künzi²,

Braunschweig

et al. 1997

Allergy

Self Cite

193

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“…In spite of the widespread use of paracetamol around the world, cutaneous side-effects from it have rarely been published : urticaria, anaphylactic shock (3), fixed drug eruption (4), maculopapular exanthemas (5), pigmentary purpura or Schamberg disease (6). Thrombopenia, urticaria, hypotension, vertigo, and malaise are the systemic sideeffects described after propacetamol i.v.…”

Section: Discussionmentioning

confidence: 99%

Occupational contact dermatitis from propacetamol

Szczurko¹,

Dompmartin²,

Michel³

et al. 1996

Contact Dermatitis

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We report 4 cases of contact sensitization to propacetamol. They presented with lesions on the hands, forearms, crease of the elbows, and neck. They were all sensitized to multiple allergens and 2 of them were atopic. Patch tests to Pro-Dafalgan and propacetamol were positive; sodium citrate and paracetamol were negative. Our cases were similar to those published for the first time by Barbaud in 1995. The only allergen was propacetamol; patch tests with diethyglycine and paracetamol were negative. Propacetamol chlorhydrate is composed of a complex paracetamol-diethylglycine, which probably acts like a hapten capable of inducing cutaneous allergy. It is an occupational allergy affecting nurses who work in surgery departments or post-anesthesia recovery rooms, where high doses of analgesics are widely used. The patients were not allergic to oral paracetamol. Despite the usual precautions, the mixture of propacetamol chlorhydrate and solvent leaks onto the nurses' hands, suggesting that health care workers handling propacetamol chlorhydrate should wear gloves.

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“…Consequently, the picture that emerges is that the majority of the delayed allergy-like reactions to X-ray CM are cutaneous manifestations, as has been reported for other drugs [13].…”

Section: Clinical Manifestationsmentioning

confidence: 94%

Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations

Christiansen¹,

Pichler

Skotland³

2000

European Radiology

127

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Iodinated X-ray contrast media are among the most frequently used pharmaceuticals for intravascular administration. Although the newer low osmolality, nonionic contrast media, are generally well tolerated, it is well known that they, like the ionic contrast media, give rise to immediate or delayed adverse reactions in susceptible individuals. In the present review, the delayed allergy-like reactions, which by definition occur more than 1 h after contrast medium administration, are described, and the possible pathophysiological mechanisms discussed. Delayed allergy-like reactions to contrast media, which have been reported to occur in 0.5-2% of recipients, are mainly mild to moderate skin reactions of the maculopapular exanthematous and urticarial/angioedematous types. Most of the reactions become apparent after a latency of 3 h to 2 days and disappear within 1 week. The incidence of more severe reactions is extremely low. Main risk factors for delayed allergy-like reactions appear to be a previous contrast medium reaction, a history of allergy, IL-2 treatment and being of Japanese descent. At present, the exact pathogenesis of these delayed reactions is still unclear. There is, however, increasing evidence that a significant proportion of the reactions are T-cell mediated.

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Time Pattern of Allergic Reactions to Drugs

Cited by 9 publications

References 5 publications

Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20‐year survey

Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20‐year survey

Occupational contact dermatitis from propacetamol

Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations

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