DRUG ALLERGY

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What Is Drug Allergy ?

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The Important of Drug Allergy

Morbidity
Mortality
Cost = extended hospitalization

Public Health Problem

Doctor Clinical Practice

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 Adverse Drug Reaction
(WHO)
a response to a drug that is:

 noxious
 unwanted
 occurs at doses normally used in man

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 Classification of adverse drug reaction
Example
Reactions
Drug Result
Predictablea
Overdosage Acetaminophen Hepatic necrosis
Sided effect Albuterol Tremor
Secondary effect Clindamycin Clostridiun difficile
pseudomembranous colitis
Drug-drug interaction Terfenadine/erythromycin Torsade de pointes arrhytmia

Unpredictableb
Intolerance Aspirin Tinnitus (at usual doses)
Idiosyncratic Chloroquine Hemolytic anemia in
G6PD-deficient patient
Allergic Penicillin Anaphylaxis
Pseudoallergic Radio contrast material Anaphylactiod reaction

aPredictable, or type A, reactions occur in otherwise normal patients, are generally dose-independent, and related to the known
pharmacologic actions of the drug.
b Unpredictable, or type B, reactions occur only in susceptible individuals, are dose-independent and not related to the
pharmacologic actions of the drug.
Solensky Roland, MD*; Med Clin N Am 90 ; 233-260 ; 2006 RS. MEDISTRA
 Classification of Drug Reaction1
Drug
Reaction

Type A Type B
Reaction Reaction
• Dose • Dose
dependent independent
• Predictable • Unpredictable
• More common • Less common

Overdose Intolerance

Idiosyncrasy
Side effects (pharmacogenetics)

Drug Drug
interaction Allergy To be continued

German DF. MGH Lange, 2008 RS. MEDISTRA

 Classification of Drug Reaction2
Drug Allergy

Immunologic reaction Pseudoallergic

(Gell and Coombs classification) reaction

Type I Type II Type III Type IV

Reaction Reaction Reaction Reaction

• IgE mediated • Antibody • Immune • T-cell-

• Anaphylactic dependent complex mediated
• Urticaria cytotoxicity damage damage
• Angioedema •IgG/IgM bind • Antibody
• Bronchopasm to antigens bindings
• Hypotension on cells • To antigens
•Complement in large
• Phagocyte quantities
German DF. MGH Lange, 2008 RS. MEDISTRA
 Idiosyncratic reaction
30 year old man develops
angioedema right eye one hour
after ingestion of 50 mg diclofenac
for relief of backache.

He is not on any other medication.

Idiosyncratic reaction: NSAID induced angioedema

Other examples of idiosyncratic reactions:

• Bronchospasmin asthmatics prescribed NSAID
• Coughassociated with ACE inhibitors
• Oculogyric crisisassociated with diphenhydramine

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Why Do Some Medications
Caused Allergy ?

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 FAKTOR
RISIKO

INDIVIDU OBAT

Dewasa >anak
Wanita > pria A. Struktur obat
Atopi Kompleks : > imunogenik
Etnik (Afrika-Amerika, Afrika , Asia)
Genetika B. Rute & cara pemberian
Polifarmasi Parenteral > oral
Penyakit hati ginjal Intermiten & berulang > kontinyu
Infeksi (HIV, virus)
SLE Topikal  jalur sensitisasi
Asma
Riwayat hipersensitifitas

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HISTORY
Hypersensitivity reactions

Does symptom-complex resemble classic allergic reactions?

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What Are The Symptoms
of Drug Allergy ?

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 Partial list of drug hypersensitivity
disorders
 Multisystem
Anaphylaxis
Serum-sickness and serum sickness- like reactions
Drug fever
Hypersensitivity syndrome
Vasculitis
Lupus erythematosus-like syndrome
Generalized lymphadenopathy

Solensky Roland, MD*; Med Clin N Am 90 ; 233-260 ; 2006

RS. MEDISTRA
 Partial list of drug hypersensitivity
disorders
 Lung  Liver
Bronchospasm Hepatitis
Pneumonitis Cholestasis
Pulmonary edema
Pulmonary infiltrates with  Heart
eoshinophilia
Myocarditis

 Kidney
Interstitial nephritis
Nephrotic syndrome

Solensky Roland, MD*; Med Clin N Am 90 ; 233-260 ; 2006

RS. MEDISTRA
Partial list of drug hypersensitivity disorders

 Skin
 Bone marrow
Urticaria/angioderma
Hemolytic anemia
Stevens-Johnson syndrome Thrombocytopenia
Toxic epidermal necrolysis Neutropenia
Fixed drug eruption Aplastic anemia
Maculopapular or Eoshinophilia
morbiliiform rashes
Contact dermatitis
Photosensitivity
Erythema nodosum

Solensky Roland, MD*; Med Clin N Am 90 ; 233-260 ; 2006

RS. MEDISTRA
 Major mucocutaneous manifestations of
drug allergy

Maculopapular rash
Urticaria or angioedema
Fixed drug eruption
Vasculitis
Toxic epidermal necrolysis
Stevens-Johnson syndrome

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RS. MEDISTRA
Which Drug Allergies The Most
Common ?

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 Allergic skin reactions to drugs received
by at least 1000 patients
Drug No. of No. of Reaction 95% confidence
reactions recipients rate* intervals
Amoxicillin 63 1225 51.4 39.0-63.8
Trimethoprim- 36 1066 33.8 23.6-46.7
sulfamethoxazole
Ampicillin 59 1775 33.2 24.9-41.5
Blood 24 1112 21.6 13.8-32.1
Dipyrone 13 3279 4.0 2.1-6.7
Atropine sulfate 2+ 1231 1.6 0.2-5.8
Mefruside 2 1229 1.6 0.2-5.9
Nitrazepam 5 3441 1.5 0.46-3.4
Furosemide 2 3830 0.5 0.06-1.9
Diazepam 2 4707 0.4 0.05-1.5
Potassium chloride 1+ 3460 0.3 0.01-1.6
* Reactions per 1000 recipients
+ Urticaria, proved by rechallenge
Bigby M. JAMA 1986;256:3358-3363 RS. MEDISTRA
 Allergic skin reactions to drugs received by 500 to 999 patients

Drug No. of No. of Reaction 95%

reactions recipients rate* confidence
intervals
Semisynthetic penicillin 14 676 20.7 11.4-34.8
Penicillin G 17 918 18.5 10.8-29.6
Acetylcysteine 7 791 8.8 3.5-18.2
Allopurinol 6 784 7.7 2.8-16.7
Bromhexine hydrochloride 4 627 6.4 1.8-16.3
Gentamicin sulfate 3 670 4.5 0.93-13.1
Pentazocine hydrochoride 4 885 4.5 1.2-11.5
Barbituates 2 505 4.0 0.5-14.3
Metoclopramide 3 929 3.2 0.7-9.5
hydrochloride
Heparin sodium 3 929 3.2 0.03-6.2

* Reactions per 1000 recipients

Bigby M. JAMA 1986;256:3358-3363 RS. MEDISTRA
Difference between serious & severe reactions

Serious adverse reaction Severe adverse

is any untoward medical
occurrence that at any dose:
reaction
'severe' is used to describe the
- results in death intensity (severity) of a
- requires inpatient specific event (as in mild,
hospitalization or prolongation moderate or severe); the
of existing hospitalization event itself, however, may
- results in persistent or be of relatively minor
significant disability / medical significance (such
incapacity as severe maculopapular
- is life-threatening rash).

RS. MEDISTRA
 Serious Allergic Reactions

Stevens Johnson Syndrome

• Purpuric macules/atypical targets
•  2 mucosal surfaces
- conjunctival, oral, genital
Toxic Epidermal Necrolysis
• Skin denudation > 30% body surface
area (BSA)

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Potentially dangerous cutaneous lesions
May progress to severe reactions
• Angioedema  oropharyngeal obstruction, anaphylaxis

• Bullous eruptions  SJS/TEN

• Erythema mutiforme  SJS/TEN

• Cutaneous vasculitis  Drug hypersensitivity syndromes

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Potentially dangerous symptoms/signs
 Eye discomfort/pain
 Injected sclera
 Oral/genital ulcers
 High fever
 Rash with skin pain
 Rapid onset of generalised urticaria,
or wheezing
 Sense of impending doom
 Feeling generally unwell

RS. MEDISTRA
Drug Allergy : Useful facts to remember

 Can affect any organ system

 Can cause fever alone
 Several organs may be affected at the
same time
 May mimic other known diseases

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How Are Drug Allergy
Diagnosed ?

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 DIAGNOSIS
ANAMNESIS
Catat semua obat
Riwayat pemakaian obat masa lalu
Lama waktu : pemakaian  gejala
Dx alergi obat sangat mungkin
obat distop  gejala hilang , obat diberi lagi  gejala timbul lagi
Obat topikal AB jgk lama  jalan sensitisasi obat

PEMERIKSAAN FISIK
PEMERIKSAAN PENUNJANG
Kolapskardiovaskular&napas
Wheezing, TD , urtikaria, demam, Ujikulit , ujiprovokasi
lesikulit, lesimembranmukosa, Laboratorium
td radang , efusisendi

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 PEMERIKSAAN PENUNJANG

UJI
UJI KULIT UJI
PROVOKASI INVITRO

•UjiIgEspesifik
(RAST, ELISA, FEIA)
•Ujitusuk (prick test)
•Ujibasofil
•Ujiintradermal (Basophil activation test
, basophil mediator
•Ujitempel (patch test) release)

•Uji mediator inflamasi

•Uji lab lain

( Coombs test,
komplemen, lymphocyte
transformation test)
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 Uji Kulit
 TERBATAS Penisilin  validasi (+) , AB lain  validasi ?

 Uji dengan obat asli

 Kurang dapat dipertanggungjawabkan kecuali Penisilin
 Kebanyakan reaksi alergi ec hasil metabolismenya, bukan obat aslinya
 Konsentrasi terlalu tinggi  dapat positif palsu
 Sebagian besar obat BM << ( hanya hapten)  sukar tentukan Ag nya

 Sebaiknya dilakukan 4-6 minggu atau tidak < 3 minggu setelah reaksi
 Dapat menginduksi reaksi anafilaksis
 Tidak membantu : manifestasi hematologi, renal, hepar, autoimun

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 Nilai prediktif negatif rendah
 Hasil uji negatif : belum menyingkirkan ketiadaan alergi
 Terkait adanya zat metabolit yg dpt menimbulkan rx
dibandingkan zat aktif obat

 Nilai prediktif positif cenderung tinggi

 Hasil uji positif : umumnya menandakan alergi
 Tetap harus diinterpretasikan sesuai perjalanan penyakit dan uji
invitro lain bila tersedia

RS. MEDISTRA
 RX TIPE LAMBAT
RX TIPE CEPAT
( delayed type / non-
(immediate type)
immediate type )

Rekomendasi :
Rekomendasi :
uji tusuk & uji intradermal
Uji tempel &uji intradermal

< sensitif, > aman

> sensitif, < spesifik

Hasil uji tempel (-) 

Hasil uji tusuk (-) 
lanjut uji intradermal
lanjut uji intradermal
evaluasi 24, 48, & 72 jam

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 Metode
UJI KULIT & UJI PROVOKASI

 Beberapa obat harus dihentikan sebelum uji kulit  TABEL

 Bebas infeksi, demam, rx inflamasi saat uji, KECUALI uji sangat
dibutuhkan
Obat Rute Intervalbebasobat
Antihistamin Oral,IV 5 hari
Antidepresan (imipramin, fenotiazin) Oral, IV 5 hari
Glukokortikoid Topikal Dapat hingga 4 minggu

Kerja panjang
Oral,IV 3 minggu
Kerja pendek, dosis tinggi
(>50 mg prednison) Oral, IV 1 minggu

Kerja pendek, dosis rendah

(<50 mg prednison) Oral,IV 3 hari
Beta blocker Oral 1 hari
Topikal (mata)
ACE-inhibitor Oral 1 hari

Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. Drug provocation test in the
diagnosis of drug hypersensitivity reactions : general considerations. Allergy 2003; 58:854-63 RS. MEDISTRA
 UJI
UJI TUSUK
INTRADERMAL

Suntik 0,02 ml alergen

Tusuk kulit perkutaneus dgn
intradermal  benjolan Ǿ 3 mm
jarum melalui solusi alergen
> sensitif , > iritatif
> mudah, > aman
> reaksi (+) palsu
< sensitif u/ RX tipe cepat
> timbul rx anafilaksis

Volar lengan bawah, dapat juga pada bagian tubuh lain

Pembacaan rx tipe cepat : 15 -20 menit
Uji tusuk hasil (-)  lanjut uji intradermal  rx tipe cepat : 15-20 menit
 rx tipe lambat : 24, 48, 72 jam
Volume larutan yang disuntikkan intrakutan JANGAN > 0,02 ml  RX (+) palsu
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POSITIF :
Ukuran benjolan ↑ > 3 mm (dibandingkan kontrol pelarut) & eritema
Diameter eritema, papul, infiltrat, eksim dengan papul, vesikel

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 UJI TEMPEL

 Tidak dilakukan pd pasien yang sebelumnya terpajan kuat sinar UV

 Dilakukan pada punggung
 Finn Chambers atau tape hipoalergik lain yang ekuivalen
 Alergen difiksasi 1-2 hari
 Hasilnya dibaca setelah 1 hari dan atau 2-3 hari

 Pembacaan : minimal 2 waktu berturutan yaitu 48 jam dan 72 jam

 Skoring European Environmental and Contact Dermatitis Research Group

Morris A. Current Allergy & Clinical Immunology 2005; 18 (3):140-42 RS. MEDISTRA
 The ‘definitive’ study on the value of
skin tests in penicillin allergy
negative skin test
History Number skin test positive skin test positive % who received pen positive rxn
negative 600 25 4,17 568 0
positive 726 139 19,15 566 7
unknown 96 3 3,13 93 0

 The history predicts the likelihood of skin test

positivity.
 It is safe to administer penicillin to skin-test-negative
patients regardless of the history.
 Sogn DD, et al. Results of the National Institute of Allergy and Infectious Diseases
Collaborative Clinical Trial to test the predictive value of skin testing with major
and minor penicillin derivatives in hospitalized adults. Arch Intern Med 1992;
152:1025-1032.

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Common Clinical indications for skin testing in the
diagnosis of drug hypersensitivity
Patch tests can be used as first Skin prick tests
line of investigation and intradermal
tests
Acute generalized exanthematous
Anaphylaxis
bustulosis
Contact dermatitis Bronchopasm
Erythema multiforme Conjunctivitis
Exanthematous drug eruption Rhinitis
Urticaria /
Fixed drug eruption
angioedema
Photoallergic reactions
Purpura / Leucocytoclastic
Vasculitis
Stevens Johnson's Syndrome
Toxic Epidermal Necrolysis
K. Brockow, A Romano, M. Blanca, et al. Allergy 2002: 57:45-51 RS. MEDISTRA
Evaluation of drug
allergy
Diagnosis of Drug Allergy is sometimes made by exclusion and
observation of recovery upon withdrawal of suspected drug.

When reaction is mild and not life threatening, and drug is needed,
careful provocative challenge may be carried out to confirm the
diagnosis.
 Provocative drug challenge
 Used to exclude rather than to prove a drug reaction
 Blinded-challenge should be used when reaction cannot be
objectively measured
 Protocols available for different drugs – basic principle of
graded challenge
 Possible risk to patient: should not be used when reaction is
an anaphylaxis, SJS or TEN
 Must be carried out in a setting with facility for resuscitation
Done  6 weeks following the suspected reaction.
RS. MEDISTRA
For large molecular
weight agents that have Evaluation of drug
multiple Ag determinants
e.g. hormones, enzymes, allergy
foreign anti-sera, a
positive test identifies
patients at risk of IgE
mediated reactions
 Skin tests
For low molecular weight •Prick followed by intradermal tests (IgE)
drugs, skin tests have a •- Patch test in selected cases
role in IgE mediated
reactions to:-lactam  In-vitro tests
antibiotics, neuromuscular
Serum specific IgE – e.g. Pharmacia CAP
-
blockers, aminoglycosides,
sulfamethoxazole  Lymhocyte transformation test,

- Measurement of mediator release

 Incremental provocation test
Less helpful clinically (drug challenge)
because of low sensitivity

RS. MEDISTRA
 Identification & future management of the most common
drug reaction

Reaction type Clinical Laboratory Future use of

characteristics testing medication
Gell & Coombs Urticaria, angioedema, Skin testing, Desensitization
Type 1 wheezing, hypotension, radioallergosorbent
nause, vomiting, testing
abdominal pain, diarrhea

Gell & Coombs Hemolytic anemia, Complete blood count Contraindicated

Type 2 granulocytopenia,
thrombocytopenia
Gell & Coombs Fever, uticaria, Complement levels Contraindicated
Type 3 arthralgias,
lymphadenopathy 2-21
days after therapy
initiated

Volcheck GW. Immunol Allergy Clin N Am. 2004;24:357-71 RS. MEDISTRA

 Identification & future management of the most common
drug reaction2

Reaction type Clinical Laboratory testing Future use of

characteristics medication
Gell & Coombs Skin erythema, skin Patch testing Likely
Type 4 blistering containdicated
Morbilliform Maculopapular rash Possibly patch Use with caution
becoming confluent testing,
intradermal skin
testing (delayed
reaction)
Erythema Distinctive target None Contraindicated
multiforme lesions

Volcheck GW. Immunol Allergy Clin N Am. 2004;24:357-71

RS. MEDISTRA
 Identification & future management of the most common
drug reaction
Reaction type Clinical Laboratory Future use of
characteristics testing medication
Stevens- Target lesions, None Contraindicated
Johnson/TEN mucous membrane
involvement, skin
desquamation
Anaphylactiod Urticaria, wheezing, None Pretreatment with
angioedema, prednisone &
hypotension Benadryl for
radiocontrast
sensitivity
HSS/DRESS Exfoliative dermatitis, Complete blood Contraindicated
fever count, liver
lymphadenopathy enzymes, creatinine,
urinalysis
Volcheck GW. Immunol Allergy Clin N Am. 2004;24:357-71 RS. MEDISTRA
 Uji kulit antibiotika beta laktam
Reagen Rute Konsentrasi obat Volume uji kulit Dosis Lain-lain

*Penicilloyl- Prick Dosis penuh 1 tetes

polylysine (PrePen) ID Dosis penuh 0,02 ml
*Penisilin G Prick 6.000-10.000 U/ml 1 tetes
Potassium ID 6.000-10.000 U/ml 0,01 ml

#Penisilin Prick Dosis penuh 1 tetes 60-100 unit

determinan minor ID Dosis penuh 0,01 ml
£Cephalosporin Prick 3 mg/ml 1 tetes 60 mcg Pengenceran serial
dan penisilin lain ID 3 mg/ml 0,02 ml 10 kali optional

£Aztreonam Prick 3 mg/ml 1 tetes 60 mcg Pengenceran serial

ID 3 mg/ml 0,02 ml 10 kali optional

£Imipenem Prick 1 mg/ml 1 tetes 20 mcg Pengenceran serial

ID 1 mg/ml 0,02 ml 10 kali optional

£Ampicilin Prick 10 mg/ml 1 tetes Pengenceran serial

ID 1 mg/ml 0,02 ml 10 kali
optional

* Uji tervalidasi
# Uji tervalidasi, reagen tidak tersedia komersil
£ Uji belum tervalidasi. Hasil negatif tidak menyingkirkan kemungkinan tidak ada reaksi

Grammer L, Greenberg P. Drug allergy and protocols for management of drug

allergies. 3rd ed. 2003 RS. MEDISTRA
CONTOH UJI PROVOKASI BEBERAPA ANTIBIOTIKA
Obat Golongan obat Dosis Pemberian Dosis lazim dewasa
Amoksisilin Penisilin 1, 5, 25, 100, 500, 1000 Oral 1000-2000 mg
Ampisilin Penisilin 1, 5, 25, 100, 500, 1000 Oral 2000 mg
Cloksasilin Penisilin 1, 5, 25, 100, 500, 1000 Oral 2000 mg
Sefaklor Cefalosporin 1, 5, 25, 125, 500 Oral 750 mg
Sefadroksil Cefalosporin 1, 5, 25, 100, 500, 1000 Oral 2000 mg
Sefatrizin Cefalosporin 1, 5, 25, 50, 250, 700 Oral 1000 mg
Sefazolin Cefalosporin 1, 5, 25, 100, 500, 2000 Intravena 1500-3000 mg
Sefuroksim Cefalosporin 1, 5, 20, 80, 400 Oral 500 mg
Seftazidim Cefalosporin 1, 5, 25, 100, 500, 2000 Intravena 3000 mg
Sefiksim Cefalosporin 1, 5, 25, 100, 225 Oral 400 mg
Seftriakson Cefalosporin 1, 5, 25, 100, 500, 1000 Intravena 1000-2000 mg
Azitromisin Makrolid 1, 5, 25, 75, 125, 250 Oral 500 mg
Klaritromisin Makrolid 1, 5, 25, 100, 500, 1000 Oral 1500-2000 mg
Eritromisin Makrolid 1, 5, 25, 100, 500, 1500 Oral 2000-3000 mg
Josamisin Makrolid 1, 5, 25, 100, 500, 1000 Oral 1000-2000 mg
Roksitromisin Makrolid 1, 5, 25, 100, 150 Oral 300 mg
Spiramisin Makrolid 15000, 75000, 325000, 750000, Oral 6-9 mIU
1500000, 4500000
Siprofloksasin Kuinolon 1, 5, 25, 100, 500 Oral 500-1500 mg
Ofloksasin Kuinolon 2, 10, 50, 100, 200 Oral 400 mg
Messaad D, SAhla H, Beahmed S, Godard P, Bousquet J, Demoly P. Drug provocation test in patients with a history suggesting an immediate
drug hypersensitivity reaction. Ann Inter Med. 2004 ;140 :1001-6
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 How Are
Drug Allergies Treated ?

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 Approach to diagnosis and management of drug allergy
Obtain full history
Thorough clinical examination
Any investigation needed?
Is it an allergy?

yes no

Determine severity of reaction Determine alternative cause

Stop drug(s) if possible of reaction
If drug needed - ? Can desensitise or Treat if necessary.
treat through reaction Could it be due to:
Document in records – underlying illness?
– coincidental second illness?
– ‘secret’ drugs like vitamins,
alternative medicines?
Further considerations:
- Patient education
- Drug Alert Card
- Report to pharmacovigilance
RS. MEDISTRA
Immediate management of drug allergy

 Stop the suspected offending drug(s)

 Hospitalization for severe immediate
(anaphylaxis) or delayed reactions
(DRESS/SJS/TEN)
 IM epinephrine, fluids, anti-histamine
(anaphylaxis)
 Systemic corticosteroids: 4-6 weeks or more
(SJS)
 High-dose IVIG 1 g/kg/day for 2 days (TEN)
 Care of skin and mucosal surfaces

RS. MEDISTRA
If drug reaction is very minor:
 Discontinue the drug most likely causing the
reaction and substitute with a chemically
unrelated compound for its indication.
 Observe for improvement.
 If improvement does not occur promptly,
choose the next most likely drug and repeat
the cycle until the reaction resolves.
 Inform the patient of the culprit drug and note
in patient’s medical record.

RS. MEDISTRA
 If reaction is severe:
 Treat the reaction symptomatically
 Discontinue all likely drugs and substitute
with chemically unrelated drugs for each
indication
 Observe for improvement

 Carry out confirmatory tests at an

appropriate time if tests are available
 Inform the patient of the culprit drug and
note in patient’s records

RS. MEDISTRA
Management of drug allergy - Desensitization
 A method of making a patient tolerant to a drug he/she
previously developed an allergic reaction to.
 Only for patients who:
 need the implicated drug and there are no reasonable alternatives (e.g.
penicillin in meningococcaemia, cotrimoxazole in PCP)
 are proven or strongly-suspected to be allergic to the drug
 did not have dangerous reactions like SJS or TEN or major organ lesions e.g.
hepatitis, but anaphylaxis is NOT a contraindication
 Patients are given progressively larger doses of the
medication according to a schedule.
 Two methods:
- ‘rapid’ - full dose within about 6-8 hrs (IgE reactions), carried out in ICU
- ‘slow’ - full dose reached after several days to weeks (maculopapular rashes)
 Tolerance can be breached if doses are missed.
 Patients are still considered to be allergic to the drug.
 How it works is unclear in most cases.
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Solensky. Drug desensitization. Immunol Allergy Clin N Am. 2004
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Prevention

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 Skema Pencegahan Reaksi Alergi Obat
Adakah obat alternatif yang efektif

Ada Tidak Ada

Obati dengan obat Uji kulit atau laboratorium

alternatif (tersedia dan dapat dipercaya)

Ya Tidak

Uji Uji Provokasi

Negatif Positif Negatif

Berikan obat Desensitisasi Teruskan

hati-hati atau pengobatan
pikirkan kembali
llternatif yang lain

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 10 Pedoman Mencegah
Reaksi Alergi Obat
1. Indikasi yang kuat dan tepat
2. Riwayat Alergi Obat
3. Obat Alternatif
4. Hindari Sensitisasi yang Tidak Perlu
5. Ingat Kemungkinan Reaksi Anafilaksis pada Orang
Atopi
6. Uji Kulit
7. Pemberian Antihistamin dan Kortikosteroid
8. Sedia Payung Sebelum Hujan
9. Penyuluhan dan Surat Keterangan
10. Catat pada Status atau Kartu Berobat

Heru Sundaru, Buletin Obat & Terapi FKUI/RSCM

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1. Medical alert brachelet1

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2. Medical alert brachelet2

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3. Emergency Kit

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4. Prevention

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THANK YOU

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