Practical Issues in Drug

Hypersensitivity
HARSOYO NOTOATMOJO
Medical Faculty Diponegoro
University/Dr. Kariadi Hospital
Semarang
 OUTLINES

• Magnitude of problems

• Practical management

• Medico Legal problems

 Introduction
Differential diagnosis :
• Drug toxicity
• Adverse drug reaction
• Intolerance
• Idiosincration, etc

Definition :
• Abnormal response against drug metabolite or drug
content through immunologic reaction
(hypersensitivity reaction)
• During or after drug usage
 Magnitude of problems

• Special cases show higher risk for antibiotic allergy,

e.g HIV-patients, cystic fibrosis

• Mechanisms involving these issues are not well

understood, maybe due to decreased gluthatione
levels, altered drug metabolism

• With the exception of penicillin, the relevant

immunogens are not known for most drugs no
valid in vivo or in vitro dx reagents available for
identifying most antibiotic-specific IgE antibodies
 Clinical features
Highly variable of type and severity of the
reaction, and organ affected, depend on factors :
1. Type of drug used
2. The nature of disease that being treated
3. The immune status of the patient

The most common reactions to antibiotics are :

1. Maculopapular skin eruptions
2. Urticaria 4. Morbilli form
3. Pruritus 5. TEN
FIGURE 1
Maculopapular exanthem.
 Clinical features…cont’d
• Some antibiotics also affect organs other
than skin

• amoxicillin-clavulanic acid can cause

cholestatic liver injury

• High-dose penicillin and cephalosporin may

cause hemolysis and cytopenias

• Anaphylaxis mediated by drug-specific IgE

antibodies
FIGURE 2
Morbilliform reaction to amoxicillin.
Fixed drug eruption.
FIGURE 9
Toxic epidermal necrolysis.
 Case report :
4 y old boy, absence seizures,
treated with lamotrigine, valproic
acid

Physical examination :
involvement of skin, oral mucosa, 1st day hospitalization
eyes

Treatment : methylprednisolon i.v,

antibiotic i.v, skin treatment

Issue : the use of corticosteroid

(risk, benefit)
10th day hospitalization
 Case report :
A boy, 8 years old, 2 days
febrile, treated with
acetaminophen

6 hours develop skin

erithematous

Skin biopsy : vasculitis due

to drug eruption
 Case report :

Steven Johnson Syndrome due

to “unknown” drug

Improvement during
hospitalization  discharge
 Case report :
A 9 years old girl admitted with
Steven Johnson Syndrome due
to antibiotic ( DD : NET)

Steroid as part of treatment

Discharge from hospital with

clinical improvement
 ISSUES

• Risk for Recurrence

• Confirmation of diagnosis

• Possibility of “outgrow” the allergy

Thank You