Drug Allergy

Any drug in the medical world can cause an allergy, as it is stated in the brochure of all drugs that if you have an allergy to that drug, you should not take it.
Any kind of unwanted drug side effect is not considered as allergy, but 10% of drug side effects that are through the immunological system and IGE involvement are considered as drug allergy, the main side effects of which are the onset of skin involvement and less cases will be digestive and respiratory or anaphylaxis. But a significant percentage of anaphylaxis cases are drug allergies.
The most drugs that cause allergies are penicillin family and then painkillers.
Anti-serum and anti-scorpion serum are also highly allergenic, so it is necessary to inject anti-allergic drugs for all people in each injection.

Like other allergies, the delayed type of drug allergy can include antibody-dependent cytotoxicity, such as antibody-dependent thrombocytopenia, or the formation of an immune complex, such as serum sickness-like syndrome, which is an example of the use of antibiotics, and the type dependent on cellular immunity that we Regarding this type, we are now going to present an article, which is also called delayed hypersensitivity, although it has different types, we will not go into details.

Only a local reaction or a systemic reaction.
Encountering these drug reactions can involve only the skin or be combined with systemic and visceral involvement, and the other type is divided into severe or non-severe, which mildly involves only the skin (itching of the skin often). It can be seen in all types,
in case of first exposure, we should be concerned about the delayed reaction of the drug, and without delay, we should ask about the severity and acceleration of this deterioration, and if it is severe, we should be hospitalized in an equipped hospital, and not only identify the drug or drugs that are the culprit, but also stop taking it immediately. and similar drugs should not be taken, this prohibition should be with the patient for the rest of his life, and it is necessary to suggest an alternative medicine and report this reaction to the authorities, and let allergists be their future advice on the path of their medicinal life and define a kind of pharmaceutical passport for patients, and in most cases these drugs are the culprit It is the first time to use them.

Local type only

Maculo-papular lesions are on the skin, which fortunately are 90% of delayed drug reactions and occur between 4 and 21 days after the start of use, although the lesions are seen less than 2 days after re-use (the date of end of use does not play a role in defining the delayed type) Lesions similar to measles (morbili form) with a good general condition, it starts from the trunk and is relieved by pressure (rarely it becomes purpuric on the legs and the pressure is still there) and if the lesion is a target, the skin inside is healthy, there is no involvement of the mucous membrane (mouth, eyes, nose) and It gets better without any treatment within 2 weeks, which is accompanied by scaling.
Medicines such as aminopenicillins, sulfonamides, carbamazepine, allopurinol, and non-steroidal analgesics play a role in causing it.

Other types only local

Delayed chronic urticaria with lichenoid eczematoid lesions and a fixed drug reaction that always causes the same lesion in the same location and intensity when using the drug.
Allopurinol sulfa called tetracycline and non-steroidal anti-inflammatory drugs are the reasons for creating a fixed model, and the fixed type is rarely large and severe, which is similar to the severe types. but it is going well.

Severe or systemic types

They are usually fatal and require hospitalization, fortunately rare

1. Erythema multiformal
   is evident from its name, that skin lesions have different shapes, sizes, and even volumes, and it is mostly due to herpes infections (cold sores) and chlamydia pneumonia, and only 20% of its cases are caused by the use of barbiturates (phenobarb, etc.), ciprofloxacin, and even non-steroid pain relievers. Aminopenicillins may involve the mucosa (mouth), but without ulceration, and if it does not progress, the mucosal ulceration will not be too severe.
2. Steven Johnson syndrome and toxic epidermal necroses
   are degrees of a disease that is the most fatal type (30% fatal) Erythema multiforme with fever, malaise, and eye and face tightness at the beginning, skin lesions first appear similar macules on the trunk and then worse The targets become a prominent wound inside, mainly vesicles and blisters, and the mucous membrane of the eyes, mouth, and genitals is caught. During the examination (even), the epidermis of the skin is separated from the underlying surface (Nikolsky’s signs)
   . Up to 10% of the skin surface involvement is Johnson’s acetone, and above 30% it becomes epidermolitoxic, and it is called an overlap between the two,
   and if it reaches 90%, it is called exfoliative dermatitis.
3. The acute general pustular reaction
   appears with redness and burning patches on the face or armpits and groin, and the fever is also severe, and a large number of purulent pustules appear quickly. It is a delayed medicine and it starts in less than two days, even less than one day, and it gets better in 2 weeks, and 80% of cases are caused by the use of antibiotics, and if we make a mistake for antibiotic treatment, the patient gets worse.
4. Induced drug hypersensitivity
   is a drug reaction of eosinophilia with systemic symptoms, it is another name with fever, malaise, joint pain, enlarged lymph nodes, hepatosplenomegaly, even involvement of the lungs and kidneys, and in the blood, an increase in eosinophils and lymphocytes (even atypical) and an increase in inflammatory markers… the onset of skin conditions From mild maculopapular to widespread involvement of all the skin with high intensity, it is the most delayed drug reaction and is seen 2 to 8 weeks after taking it, and it is very long and permanent, and it lasts for weeks, and it gets better slowly, and there are even phases of recovery, and during the course of the disease, viruses It also awakens the latent, which increases the severity of the disease. It occurs mostly in elderly people over 60 years old, and anticonvulsant drugs such as carbamazepine are the cause.
5. Medicinal vasculitis
   is the creation of auto-immunity with drugs, which in the skin causes purpura and lupus-like lesions along with arthritis and muscle inflammation or kidney and lung involvement, and in the blood, an increase in ANA and anticardiolipin NK, an increase in immunoglobulin M, and a decrease in complement C4, distinguishing medicinal vasculitis from the idiopathic type, these abnormal tests in It is a drug model and the most important drug that causes vasculitis is anti-thyroid drugs, and it occurs even months after the start of anti-thyroid drugs.
   Kidney or liver involvement has been separately reported as a drug reaction up to 3 months after the start of use.

Clinical exposure
has not caused a reaction, so that drug is not considered to be charged for skin lesions that have started more than a few days or is very unlikely.
If the history of previous use and the same lesions have been repeated, it is certain that the drug is the culprit, although most of the cases are due to consumption in the first place, and usually no one uses it anymore. ).
The first step is
to stop the drug. It is very important to stop the culprit drug as soon as possible. It is the first step. However, we must be careful not to blame all the drugs and not to stop taking the drug that is not blamed so that the underlying problem does not become a problem.
Exceptions:
Although the culprit drug has been identified, due to the mildness of the lesions or due to the importance of the underlying disease, sometimes we continue to use the culprit drug, which we have to do in the hospital, such as the treatment of nemocystic carinitis in AIDS with sulfonamide.

We said that if we do not treat mild or benign maculopapules, they will get better within two weeks, although antihistamines or lotions such as calamine are prescribed due to itching, and if the itching is more severe, mild to moderate corten ointment is used, but generally Drug sensitivity does not have an antidote (neutralizer).
Treatment of severe cases
in a hospital equipped with a burn ward or ICU, a separate and sterile room with a special nurse and a warm and humid environment with facilities for treating acute skin failure (water and electrolyte replacement and prevention of infection). Skin support with lotion. Various corticosteroids and strong ointments, appropriate dressings and lukewarm water baths for the weeks of hospitalization and in case of severe systemic corticosteroids, especially in the case of lung and kidney involvement, for a period of time when recovery occurs, usually 1-2 weeks, when he can receive pulses, and for 6 to 8 weeks, high and reduced doses of corticosteroids Gradual within 6 months to 12 months (monitor with NK antibody)
Antiviral treatment in case of activation of viral infection and if secondary infection occurs, it should be treated carefully and any drug that has a similar structure should not be used at all,
unlike idiopathic scolitis, it is rarely needed. We use cyclosporine or anti-TNF (Etransp).
In summary, the treatment is all-round support.
The follow-up of
complications such as dry skin and dry eyes, corneal ulcers, eyelash entropion, and symblephoren in the eyes and nail dystrophy should be considered in the follow-up visit. The follow-up plan depends on the severity. Between 1 and 3 months is required for at least one year.
The possibility of developing autoimmunity is very high in these people, which includes type 1 diabetes and Graves’ and autoimmune hemolytic anemia, especially in the systemic type, multidrug sensitivity and reactions to drugs of the same family and similar, for example, the family of anticonvulsant treatment has cross-reactions and It can be seen between phenytoin and phenobarb and working with mazepin and lemotrigine, and of course sodium and alporate, which is not cyclic, has no problem.
If he is allergic to sulfonamide (cotrimaxazole), any type of antibiotic (for example, vaginal suppository) is contraindicated, but thiazide and sulfonylurea diabetes is not a problem, and probably sulfosalazine.