Table 2. Classification of Adverse Reactions to Biologics Type of Adverse Reaction High dose
Example Hypersensitivity
Secondary immunodeficiency Autoimmunity Atopic disorders Cross-reactivity
Cytokine release syndrome Delayed infusion reactions Tuberculosis with anti-TNF SLE or vasculitis Atopic dermatitis
Acne from anti-epidermal growth factor receptor
Nonimmunologic adverse effects Depression from interferons Diagnosis and Assessment
Risk Factors
ÎThe most important risk factors for drug hypersensitivity may be related to the chemical property and molecular weight of drugs. (C)
ÎOther drug-specific risk factors for drug hypersensitivity include the dose, route of administration, duration of treatment, repetitive exposure to the drug, and concurrent illnesses (eg, Epstein-Barr virus infection and amoxicillin rash). (C)
ÎHost risk factors for drug hypersensitivity include age, sex, atopy, underlying diseases (such as lupus erythematous and human immunodeficiency virus [HIV]), and specific genetic polymorphisms. (C)
Clinical Evaluation and Diagnosis of Drug Allergy
ÎThe history should focus on previous and current drug use and the temporal sequence of events between initiation of therapy and onset of symptoms. (C)
ÎPhysical examination should include all systems that could possibly account for the clinical presentation. (C)
ÎCutaneous manifestations are the most common presentation for drug allergic reactions. Characterization of cutaneous lesions is important in regard to determining the cause, further diagnostic tests, and management decisions. (C)
ÎNumerous cutaneous reaction patterns have been reported in drug allergy, including exanthems, urticaria, angioedema, acne, bullous eruptions, fixed drug eruptions, erythema multiforme, lupus erythematosus, photosensitivity, psoriasis, purpura, vasculitis, pruritus, life-threatening cutaneous reactions such as SJS, TEN, exfoliative dermatitis, and DRESS. (C)
5
