DRUG ALLERGY

Dr Sana Nisar
Zaidi

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OBJECTIVES
 Definition
 Properties
 Clinical types
 Mechanism of reactions
 Prevention & management
 Desensitization
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DEFINITION

It is an acquired
qualitatively
altered
response of
body to a drug
due to antigen
antibody
reaction .
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 It occurs as a result of
exposure to a drug so that
drug or its metabolite acts as
sensitizing agent.
 The allergy is manifested on
reexposure to the same or
immunologically related drug.
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 High molecular weight

( Protiens, peptides,
polysacchrides )
 Low molecular weight ( Haptens
i.e incomplete antigen )
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 Sensitization by antigens
cause the formation of specific
antibodies either circulating in
the blood or fixed in the
tissues.
 Upon re administration of
drug ,the antigen reacts with
the antibody.
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 The antigen antibody reaction

ultimately releases mediators
( histamine, bradykinin,
serotonin etc )
 These causes skin reaction,
respitatory reactions,GIT
reactions,blood and blood
vessels reactions.
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PROPERTIES

 Abnormal, unexpected and

qualitatively different from the
properties of drug
 Not dose dependent
 Delay in its exposure and on
rexposure it is fast
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 Occur in Small number of

patients
 Disappear on stopping and
reappear on starting the drug
 Different response in different
persons by same drug
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 Allergic patient ( eczema ) are

prone to develop drug reaction
 Some drugs are more likely to
cause reaction e.g. penicillin
 It is possible to achieve
desensitization
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CLINICAL TYPES

 Acute reactions
 Subacute reactions
 Delayed reactions
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ACUTE REACTIONS

 Within minutes of
administration of drug
 E.g Anaphylactic reactions
 Drugs penicillins, vaccines,
iron injections, horse serum
etc.
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14 SUBACUTE REACTIONS

 Occurs in hours between 1 to

24 hours
 Rarely after a few days
 Urticaria & angioneurotic
edema acompanied by itching
with involvement of face ,
eyelids
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 Others complications are

dermatitis, conjunctivitis,
arthralgia, agranulocytosis,
aplastic anaemia, fever, rhinitis
etc
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 It takes about 1 to 3 weeks

 Serum sickness syndrome
 Organ transplant reactions.
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MECHANISM OF
REACTIONS

 Type I:
 IgE-mediated acute allergic
reactions to stings, pollens,
and drugs, including
anaphylaxis, urticaria, and
angioedema.
 .
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 IgE is fixed to tissue mast cells

and blood basophils, and after
interaction with antigen the
cells release potent mediators
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 Type II:

 Drugs often modify host

proteins, thereby eliciting
antibody responses to the
modified protein.
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 These allergic responses

involve IgG or IgM in which the
antibody becomes fixed to a
host cell, which is then subject
to complement dependent lysis
or to antibody-dependent
cellular cytotoxicity.
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 Type III:
 Drugs may cause serum
sickness, which involves
immune complexes containing
IgG and is a multisystem
complement-dependent
vasculitis that may also result
in urticaria.
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 Type IV:
 Cell-mediated allergy is the
mechanism involved in
allergic contact dermatitis
from topically applied drugs
or induration of the skin at
the site of an antigen injected
intradermally.
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 Some adverse reactions to

drugs may be mistakenly
classified as allergic or
immune when they are actually
genetic deficiency states or are
idiosyncratic and not mediated
by immune mechanisms
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 eg, hemolysis due to

primaquine in glucose-6-
phosphate dehydrogenase
deficiency, or aplastic anemia
caused by chloramphenicol).
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DRUG TREATMENT OF
ALLERGY

 One can test an individual for

possible sensitivity to a drug
by a simple scratch test,
 i.e, by applying an extremely
dilute solution of the drug to
the skin and making a scratch
with the tip of a needle.
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 If allergy is present, an
immediate (within 10–15
minutes) wheal (edema) and
flare (increased blood flow) will
occur.
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 Prednisone, often used in

severe allergic reactions, is
immunosuppressive, since
glucocorticoids are generally
toxic to lymphocytes.
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 Epinephrine opposes
histamine; it relaxes
bronchiolar smooth muscle
and contracts vascular muscle,
relieving both bronchospasm
and hypotension.
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 The antihistamines
competitively inhibit histamine,
which would otherwise
produce bronchoconstriction
and increased capillary
permeability in the end organ.
 Glucocorticoids may also act
to reduce tissue injury and
edema
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DESENSITIZATION TO
DRUGS

 When reasonable alternatives

are not available, certain drugs
(eg, penicillin, insulin) must be
used for life-threatening
illnesses even in the presence
of known allergic sensitivity.
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 In such cases, desensitization

can sometimes be
accomplished by starting with
very small doses of the drug
and gradually increasing the
dose over a period of hours to
the full therapeutic range.
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