Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • hx of drug exposure
  • skin lesions
  • variable skin reactions within 5 to 15 minutes of drug exposure
  • variable skin reactions within a few hours of drug exposure
  • variable skin reactions within 2 weeks of drug exposure
  • variable skin reactions within months to years of drug exposure
  • previous exposure and reaction to drug

Other diagnostic factors

  • morbilliform eruptions
  • pruritus
  • associated non-cutaneous features
  • pain

Risk factors

  • virus infections
  • HIV infection
  • HLA-B*5701 polymorphism
  • HLA-B*1502 polymorphism
  • HLA-B*5801 polymorphism
  • female gender

Diagnostic investigations

Investigations to consider

  • blood (whole blood, plasma, serum) drug concentration
  • serum tryptase concentration (anaphylaxis)
  • complement pathway assay
  • histology of lesion biopsy
  • FBC and differential
  • anti-histone antibodies to single-stranded DNA (lupus-like syndrome)
  • skin tests (prick tests, intradermal tests, patch tests)
Full details

Emerging tests

  • drug-specific IgE
  • basophil activation test
  • lymphocyte proliferation assay (LPA/LTT)
  • enzyme-linked immunospot assay (ELISPOT test)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Consultant Dermatologist

Faculty of Medicine

University of Southampton

Southampton

UK

Disclosures

MA-J declares that he has no competing interests.

Clinical Fellow

Clinical & Experimental Sciences

Faculty of Medicine

University of Southampton

Southampton

UK

Disclosures

WYH declares that he has no competing interests.

Dr Michael Ardern-Jones and Dr Wei Yann Haw would like to gratefully acknowledge Dr Anne Holbrook, Dr Hermenio Lima, and Dr Jeffrey K. Aronson, the previous contributors to this monograph. AH and HL declare that they have no competing interests. JKA is editor of Meyler's Side Effects of Drugs and its annual companion volumes, the Side Effects of Drugs Annuals.

Peer reviewers VIEW ALL

Specialist Dermatologist

Ayza Skin & Research Center

Lalamusa

Pakistan

Disclosures

SAJ declares that he has no competing interests.

Dean

College of Pharmacy, Nursing, and Health Sciences

Purdue University

West Lafayette

IN

Disclosures

CKS declares that he has no competing interests.

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