ÎDrugs most commonly associated with cutaneous DILE include hydrochlorothiazide, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and systemic antifungal agents. Anti-Ro and anti-SSA antibodies are usually present, whereas antihistone antibodies are much less frequent. (C)
ÎThe recognition of immunologically mediated, drug-induced granulomatous disease with or without vasculitis has increased in recent years. (C)
ÎImmunologic hepatitis may occur after sensitization to para- aminosalicylic acid, sulfonamides, and phenothiazines. (C)
ÎErythema multiforme minor is a cell-mediated hypersensitivity reaction associated with viruses, other infectious agents, and drugs. It manifests as pleomorphic cutaneous eruptions, with target lesions being most characteristic. (C)
ÎThere is no consensus on the distinction between erythema multiforme major and Stevens-Johnson syndrome (SJS). These disorders involve mucosal surfaces as well as the skin. (D)
ÎUse of systemic corticosteroids for treatment of erythema multiforme major or SJS is controversial. (D)
ÎToxic epidermal necrolysis ([TEN], ie, Lyell syndrome) is distinguished from SJS by the extent of epidermal detachment. (D)
ÎSystemic corticosteroids are associated with increased mortality when used for the management of advanced TEN (C). Treatment with high-dose intravenous immunoglobulin is controversial. (D)
ÎManage TEN in a burn unit. (D)
ÎSerum sickness-like reactions caused by cephalosporins (especially cefaclor) usually are due to altered metabolism of the drug, resulting in reactive intermediates. (B)
ÎImmunologically mediated nephropathies may present as interstitial nephritis (such as with methicillin) or as membranous glomerulonephritis (eg, gold, penicillamine, and allopurinol). (C)
Other Classification Systems for Drug Allergy
ÎIn addition to Gell-Coombs hypersensitivity reactions, there are a number of other mechanistic and clinical classifications for drug allergy. (C)
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