Allergic Reactions to Drugs and Biologic Agents

Abstract

Drug allergies are adverse reactions resulting from immunologic responses to drugs or their metabolites. These reactions result in predictable patterns of organ-specific or systemic hypersensitivity that usually recur on subsequent exposure to the same drug. Although diagnostic testing for drug allergy is available for only a few drugs, protocols have been developed to assist in management of allergic reactions to many drugs and biologic agents. Other protocols assist in the management of patients who develop drug reactions while undergoing multiple drug therapy or those with a history of adverse drug reactions who again require treatment for the same condition.

Adverse reactions to infliximab and the outcome of desensitization

“…It has been postulated that the procedure could cause the formation of the univalent hapten carrier protein inhibiting IgE cross-linking on mast cells or possible intracellular signaling inhibition in the mast cell triggered by low-drug concentrations. 15 In conclusion, effective infliximab therapy does not need to be discontinued in patients who develop systemic reactions. Desensitization can be successful in allowing the continuation of therapy, with only minor adverse reactions that can be easily managed or prevented.…”

Is Antibiotic Prophylaxis for Bacterial Endocarditis Cost-Effective?

“…21,23,25,26 Because only a single dose of antibiotic is used for endocarditis prophylaxis, adverse reactions from antibiotics were limited to hypersensitivity or allergic-type reactions only. Other adverse effects such as clostridium difficile colitis, nonspecific gastrointestinal upset, headaches, and the development of resistant bacterial infections were not included.…”

CD30+ Lymphomatoid Drug Reactions

“…Although only 5%-10% of drug reactions are thought to be immunologically mediated, 25 each of the implicated drugs in this series has been known to cause hypersensitivity reactions. Four of the 5 patients were taking more than one drug associated with immune dysregulation or hypersensitivity, and an additive effect has been reported in the past.…”

“…25 Most of the suspected causative agents in the cases we described fall within these categories: amlodipine is a calcium channel blocker, and sertraline is an antidepressant. Amlodipine, carbamazepine, cefuroxime, valsartan, and combined treatment with cyclosporin and infliximab have been implicated previously as the causative agent for other cases of CD30+ pseudolymphomas.…”