II. Types: Medication-induced Hypersensitivity Reaction

IV. Risk factors: Immune-mediated Drug Reaction

  1. Drug Hypersensitivity Reaction to related medication
  2. Adults (especially women)
  3. Concurrent Viral Infection
  4. Comorbid condition
    1. HIV Infection
    2. Asthma
    3. Systemic Lupus Erythematosus
    4. Beta Blocker use
  5. Medications with larger more complicated structure
    1. Non-human Proteins
    2. Streptokinase
    3. Insulin

V. Findings: Suggestive of Drug Hypersensitivity

  1. See Life-Threatening Drug-Induced Rashes
  2. Anaphylaxis
  3. Angioedema
  4. Urticaria
  5. Morbilliform rash (80% of drug rashes in adults, 35% in children)
    1. Occurs 4 to 21 days after onset of exposure
    2. See Fixed Drug Eruption
  6. Bullous Disease
    1. See Drug-Induced Bullous Disease
    2. Erythema Multiforme
    3. Toxic Epidermal Necrolysis

VI. Management

  1. Avoid drug responsible for adverse reaction
  2. Consider testing for allergy if suspect immune-mediated
    1. Type 1 Hypersensitivity Reaction
      1. Skin Testing
      2. RAST Testing
    2. Type 2 Hypersensitivity Reaction
      1. Coombs' Test positive
      2. Complete Blood Count
        1. Hemolytic Anemia
        2. Thrombocytopenia
        3. Neutropenia
    3. Type 3 Hypersensitivity Reaction
      1. Erythrocyte Sedimentation Rate (ESR) increased
    4. Type 4 Hypersensitivity Reaction
      1. Patch Testing
  3. Consider Desensitization to offending agent
  4. Consider specific agent management
    1. Penicillin Adverse Drug Reaction
    2. Intravenous Contrast

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Related Studies

Ontology: Drug Eruptions (C0011609)

Definition (NCI) An eruption in the skin due to exposure to a pharmacologic substance.(NICHD)
Definition (MSH) Adverse cutaneous reactions caused by ingestion, parenteral use, or local application of a drug. These may assume various morphologic patterns and produce various types of lesions.
Concepts Disease or Syndrome (T047)
MSH D003875
SnomedCT 402749008, 200891009, 28926001, 275447008, 403675008
English Dermatitis Medicamentosa, Drug Eruptions, Eruption, Drug, Eruptions, Drug, Dermatitis, Adverse Drug Reaction, DERMATITIS MEDICAMENTOSA, DRUG ERUPTION, Drug Eruption, dermatitis medicamentosa (diagnosis), dermatitis medicamentosa, generalized dermatitis due to drugs and medicines (diagnosis), generalized dermatitis due to drugs and medicines, Drug Eruptions [Disease/Finding], drug rash, Dermatitis;drug induced, drug eruptions, drugs rash, drug eruption, drug induced dermatitis, medicamentosa dermatitis, drug induced rash, Dermatosis precipitated by drug therapy (disorder), Dermatosis precipitated by drug therapy, Drug induced rash, Drug-induced cutaneous eruption, Drug Rash, Drug Skin Rash, Drug eruption, Dermatitis medicamentosa, Drug-induced rash, Dermatitis medicamentosa (disorder), Drug rash, Drug-induced dermatosis (disorder), Drug-induced dermatosis, Eruption due to drug (disorder), Eruption due to drug, drug; eruption, drug; rash, eruption; drug, rash; drug, Drug eruption, NOS, Drug rash, NOS, Eruption due to drug, NOS, Drug eruption NOS, Dermatitis medicamentosa NOS, drug induced dermatits
German ARZNEIMITTELEXANTHEM, Medikamentenausschlag NNB, Dermatitis medicamentosa, DERMATITIS MEDICAMENTOSA, Medikamentenausschlag, Arzneimittelexanthem, Dermatitis, Arzneimittel-, Dermatitis, Arzneimittelnebenwirkungs-
Portuguese DERMATITE MEDICAMENTOSA, Dermatite medicamentosa, Erupção medicamentosa NE, ERUPCAO MEDICAMENTOSA, Erupção medicamentosa, Dermatite Medicamentosa, Dermatite por Reação Adversa a Droga, Erupção por Droga
Spanish DERMATITIS MEDICAMENTOSA, Erupción medicamentosa NEOM, Dermatitis medicamentosa, Exantema medicamentoso, ERUPCION MEDICAMENTOSA, sarpullido medicamentoso, salpullido medicamentoso, erupción por drogas, dermatosis precipitada por tratamiento farmacológico, dermatosis precipitada por tratamiento farmacológico (trastorno), dermatitis farmacógena, dermatitis medicamentosa (trastorno), dermatitis medicamentosa, dermatosis medicamentosa (trastorno), dermatosis medicamentosa, erupción medicamentosa (trastorno), erupción medicamentosa, rash medicamentoso, Erupción medicamentosa, Dermatitis Medicamentosa, Dermatitis por Reacción Adversa a Medicamentos, Erupciones por Medicamentos
Italian Eruzione da farmaci, Eruzione da farmaci NAS, Dermatite da farmaci, Dermatite da reazione avversa a farmaco, Dermatite medicamentosa, Eczema medicamentoso
Dutch geneesmiddelenuitslag, dermatitis medicamentosa, geneesmiddeleneruptie NAO, eruptie; geneesmiddel, geneesmiddel; eruptie, geneesmiddel; uitslag, uitslag; geneesmiddel, geneesmiddeleneruptie, Artsenijexantheem, Dermatitis medicamentosa, Eruptie, geneesmiddelen-, Geneesmiddeleneruptie, Toxicodermie
French Eruption médicamenteuse SAI, Dermite médicamenteuse, Rash médicamenteux, DERMITE MEDICAMENTEUSE, ERUPTION MEDICAMENTEUSE, Eruption d'origine médicamenteuse, Toxidermies, Dermatite médicamenteuse, Toxidermie médicamenteuse, Éruptions médicamenteuses
Japanese 薬剤性皮膚炎, 薬疹NOS, ヤクシン, ヤクザイセイヒフエン, ヤクシンNOS, 薬疹, 皮膚炎-薬物性, 薬物副作用性皮膚炎, 薬物性皮膚炎, 皮膚炎-薬物副作用性, 薬物皮膚炎
Swedish Läkemedelsutslag
Czech dermatitida léková, Poléková dermatitida, Polékový kožní výsev, Poléková vyrážka, Polékový kožní výsev NOS
Finnish Lääkeihottumat
Polish Wysypka polekowa, Osutka lekowa, Zapalenie skóry polekowe
Hungarian Gyógyszer kiütés k.m.n., Gyógyszeres kiütés, Dermatitis medicamentosa, Gyógyszer kiütés
Norwegian Legemiddelutløste utslett, Utslett, medikamentinduserte, Medikamentinduserte utslett, Utslett, medikamentelt induserte, Medikamentelt betingede utslett, Medikamentelt utløste utslett, Utslett, medikamentelt utløste, Utslett, medikamentelt betingede, Medikamentelt induserte utslett, Utslett, legemiddelutløste

Ontology: Adverse reaction to drug (C0041755)

Definition (MEDLINEPLUS)

Most of the time, medicines make our lives better. They reduce aches and pains, fight infections, and control problems such as high blood pressure or diabetes. But medicines can also cause unwanted reactions.

One problem is interactions, which may occur between

  • Two drugs, such as aspirin and blood thinners
  • Drugs and food, such as statins and grapefruit
  • Drugs and supplements, such as gingko and blood thinners
  • Drugs and diseases, such as aspirin and peptic ulcers

Interactions can change the actions of one or both drugs. The drugs might not work, or you could get side effects.

Side effects are unwanted effects caused by the drugs. Most are mild, such as a stomach aches or drowsiness, and go away after you stop taking the drug. Others can be more serious.

Drug allergies are another type of reaction. They can be mild or life-threatening. Skin reactions, such as hives and rashes, are the most common type.

When you start a new prescription or over-the-counter medication, make sure you understand how to take it correctly. Know which other medications and foods you need to avoid. Ask your health care provider or pharmacist if you have questions.

Definition (SCTSPA) Toda respuesta nociva y no deseada a un producto medicinal, relacionada con cualquier dosis, se debe considerar una reacción medicamentosa adversa (del Lineamiento para la Industria, Manejo de Datos de Seguridad Clínica: Definiciones y Normas para la Comunicación Expedita, de la FDA de EE.UU.)
Definition (SNOMEDCT_US) All noxious and unintended responses to a medicinal product related to any dose should be considered adverse drug reactions (from US FDA 'Guideline for Industry, Clinical Safety Data Management: Definitions and Standards for Expedited Reporting').
Definition (PSY) Acute or chronic and often undesirable effects of drugs occurring in addition to the intended or therapeutic objective.
Definition (CSP) unintended, deleterious effects of otherwise licit, therapeutic, properly administered drugs; for effects of illicit and abused drugs, or of environmental chemicals, see TOXICOLOGY or POISONING.
Concepts Injury or Poisoning (T037)
MSH D064420
ICD10 T88.7
SnomedCT 219105008, 158060007, 212996000, 62014003, 264519003
DSM4 995.2
LNC LA7429-9
English drug adverse effect, Adverse Effects of Medication NOS, Drug Side Effects, Adverse reaction to drug NOS, Drug side effect, Adverse drug reaction NOS, adverse drug effect, side effect (drug), Adverse reaction to drug, Drug reaction NOS, medication side-effect, Adverse effect;medication, medication reaction, adverse drug reaction, adverse drug event, drug side effect, Side-effect;medication, medication adverse effects, medication side effect, medication side effects, adverse drug reactions, medications side effect, drug adverse reaction, medication reactions, medications reaction, medications reactions, reaction medication, drug adverse reactions, drug side effects, adverse drug effects, adverse drug events, adverse reaction to drug therapy, adverse effect of drug therapy (diagnosis), adverse effect of drug therapy, Drug Reactions, Reactions, Adverse Drug, Events, Adverse Drug, Drug Event, Adverse, Drug Reactions, Adverse, Adverse Drug Event, Drug Reaction, Adverse, Adverse Drug Events, Adverse Drug Reactions, Adverse Drug Reaction, Drug Events, Adverse, Reaction, Adverse Drug, Event, Adverse Drug, Adverse reaction to drug NOS (disorder), Adverse drug effect, Drug reaction, ADR - Adverse drug reaction, Adverse drug reaction, Drug reaction (qualifier value), Adverse reaction to drug (disorder), drug; adverse effect, drug; reaction, drug; use, adverse effect, drugs; adverse effect, adverse effect; drugs, reaction; drug, Adverse drug effect, NOS, Adverse drug reaction, NOS, Drug reaction, NOS, Adverse reaction to drug NOS (finding), Side Effects (Drug), Drug Adverse Reactions, drug reaction, side-effect of medication
Italian Reazione avversa da farmaci, Reazione avversa da farmaci, NAS, Effetto collaterale di farmaco, Reazione avversa da farmaco
Dutch geneesmiddelenbijwerking NAO, geneesmiddelbijwerking, drug; reactie, drugs; ongewenst gevolg, geneesmiddel; gebruik, ongewenst gevolg, geneesmiddel; gevolg, ongewenst gevolg; drugs, reactie; geneesmiddel of drug, geneesmiddelenbijwerking
French Réaction indésirable à un médicament SAI, Effet secondaire médicamenteux, Événement indésirable médicamenteux, Événement médicamenteux indésirable, Effet médicamenteux indésirable, Événement iatrogène médicamenteux, Événement iatrogénique médicamenteux, Évènement indésirable médicamenteux, Réaction indésirable aux médicaments, Événement médicamenteux iatrogénique, Effet indésirable des médicaments, Réaction indésirable médicamenteuse, Événement médicamenteux iatrogène, Effet indésirable médicamenteux, Réaction médicamenteuse indésirable, Réaction indésirable à un médicament
German unerwuenschte Arzneimittelwirkung NNB, Medikamentennebeneffekt, Unerwuenschte Nebenwirkung, Unerwuenschte Arzneimittelreaktion, Unerwuenschte Arzneimittelwirkung, Unerwünschte Arzneimittelreaktion, Unerwünschte Nebenwirkung, Arzneimittelnebenwirkung, Unerwünschte Arzneimittelwirkung, unerwuenschte Arzneimittelwirkung
Portuguese Reacção adversa a fármacos NE, Efeito secundário de fármaco, Reacção adversa a fármacos
Japanese 医薬品副作用NOS, 医薬品副作用, イヤクヒンフクサヨウ, イヤクヒンフクサヨウNOS
Spanish Efecto secundario de un fármaco, Reacción adversa a medicamentos NEOM, reacción adversa a fármaco, SAI, reacción adversa a fármaco, SAI (trastorno), Adverse reaction to drug NOS, efecto adverso de una droga, reacción adversa a un fármaco (trastorno), reacción adversa a un fármaco, reacción medicamentosa (calificador), reacción medicamentosa, Reacción adversa a fármacos, reacción adversa a fármaco, SAI (hallazgo)
Czech Nežádoucí účinek léku NOS, Nežádoucí účinek léku, Postranní účinek léku, léky - vedlejší účinky, léky - nežádoucí účinky
Hungarian Gyógyszer-mellékhatás k.m.n., Gyógyszer mellékhatás
Norwegian Legemiddelbivirkning, Bivirkninger


Concepts Injury or Poisoning (T037)
ICD9 E930-E949.9
SnomedCT 218256004, 158007008
English Adv reac drug/medic/biol subs, Adverse reaction to drugs/medicines/biological substances, Drugs, medicines and biological substances causing adverse effects in therapeutic use, Drugs, medicines and biological substances causing adverse effects in therapeutic use (finding), Drugs, medicines and biological substances causing adverse effects in therapeutic use (event), DRUGS, MEDICINAL AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE
Spanish fármacos, medicamentos y sustancias biológicas que producen efectos adversos durante la utilización terapéutica, fármacos, medicamentos y sustancias biológicas que producen efectos adversos durante la utilización terapéutica (hallazgo)