Treatment Management and Prevention of Drug Allergic Reactions
ÎIdeally ADRs should be prevented. Steps to prevent allergic drug reactions include (1) a careful history to determine host risk factors, (2) avoidance of cross-reactive drugs, (3) use of predictive tests when available, (4) proper and prudent prescribing of drugs (especially antibiotics) that are frequently associated with adverse reactions, (5) use of oral drugs when possible, and (6) documentation of ADR in the patient's medical record. (D)
ÎFor some allergic drug reactions, withdrawal of the drug may be all that is required for treatment. (C)
ÎAnaphylactic drug reactions require prompt emergency treatment as discussed extensively in "The Diagnosis and Management of Anaphylaxis practice parameter: 2010 update." (J Allergy Clin Immunol. 2010;126:477-480). (B)
ÎGlucocorticosteroids may be required for immune complex reactions, drug-induced hematologic diseases, early stages of erythema multiforme major/SJS, and contact sensitivities. (C)
ÎWhat has often been referred to as drug desensitization is more appropriately described herein as a temporary induction of drug tolerance. (D)
ÎInduction of drug tolerance modifies a patient's response to a drug to temporarily allow treatment with it safely. It is indicated only in situations where an alternate non–cross-reacting medication cannot be used. (B)
ÎThrough various mechanisms, induction of drug tolerance induces a temporary state of tolerance to the drug that is maintained only as long as the patient continues to take the specific drug. (B)
ÎImmunologic IgE induction of drug tolerance (drug desensitization) is the progressive administration of an allergenic substance to render effector cells less reactive. These procedures typically are performed within hours, and the typical starting dose is in the microgram range. (B)
ÎFor some delayed non–IgE-mediated cutaneous reactions, immunologic non-IgE induction of drug tolerance may be performed to allow treatment with the drug. However, it is generally contraindicated, with rare exceptions, for serious non–IgE-mediated reactions, such as SJS or TEN. One example of when the benefit of treatment may outweigh the risk of reaction is imatinib for treatment of malignant tumors. (C)
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