Mnemonics: Drug Allergy

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

When drug reactions resembling allergy happen, they are called drug hypersensitivity reactions (DHRs). Drug hypersensitivity reactions may be allergic or nonallergic. Drug allergies are drug hypersensitivity reactions caused by the immune system.

T cell-meditated drug hypersensitivity subclassified as types IVabcd

IVa - 1 = Th1
IVb - 2 = Th2
IVc = cytotoxic CD8 T cells
IVd

Diagnosis of drug allergy

HASTA la vista (Spanish, See you later)

History
Assemble a list of drugs and rank them
Stop all drug candidates
Test
Administer - dose escalation or desensitization

Classification of adverse reactions to drugs: SOAP III

Side effect
Overdose
Allergy
Pseudoallergy

Interaction
Intolerance
Idiosyncrasy



Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image).

Rule of 10s in ADR

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10 % of these lead to death

Mnemonics for penicillin allergy skin testing

Major penicillin determinant test detects
Majority of patients with penicillin allergy

Minor determinant test
Minorizes the risk

Manifestations of beta-lactams hypersensitivity: MAUS

Maculopapular exanthema, 19%
Anaphylaxis without shock, 19%
Urticaria, 36%
Shock, anaphylactic shock, 17%

References: Clinical presentation and time course in hypersensitivity reactions to β-lactams. Allergy, 2007.

Samter's triad include asthma, aspirin sensitivity, and nasal/ethmoidal polyposis:

ASPirin
Asthma
Sensitivity to aspirin
Polyps

T
Toxic epidermal necrosis (TEN)
Thirty percent of the skin (SJS less than 10%)
"Terrible" prognosis

Management of adverse drug reactions: PAD

Premedication with antihistamines and steroids
Avoidance
Desensitization

Published: 10/01/2009
Updated: 03/01/2014

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