Ketut Suardamana
Ketut Suryana
Division of Allergy-Immunology
Department of Internal Medicine, Faculty Medicine of
Udayana University
Denpasar
DEFINITION
An ADR is
any undesirable effect of drug
that is administered in standard doses
by the proper route for the purpose of
prophylaxis, diagnosis, or treatment.
Classification of ADR ADR
Overdose Intolerance
Immunologic reaction
Pseudoallergic reaction
(Gell and Coombs classification
Drug related
Macromolecular size ; bivalency, haptens,
route, dose, duration of treatment
Aggravating factors
Blockers, asthma, pregnancy
Diagnosis
Diagnosis of drug allergy based on ;
Clinical history
Clinical manifestations
Diagnostic test
Clinical history
A precise and detailed history, including ;
- clinical symptoms and their timing, duration in relation to drug
exposure.a
- the onset may be ;
- immediate (onset second to minutes / < 6 hrs) :
e.g : anaphylaxis,urticaria,angioedema,bronchospasm
- accelerated ( > 6 hrs to 72 hrs ) :
e.g : urticaria,bronchospasm, erythema multiforme,
maculopapular rash, Serum sickness
- delayed ( > 72 hrs ) :
e.g : maculopapular rash, fever, serum sickness, recurrent
urticaria
- The past history
- The family history
Clinical manifestations
Manifestation Clinical features Examples of drugs
Anaphylaxis Urticaria, angioedema, rhinitis, Penicillin, neuromuscular blocking drugs
asthma, abd. pain, CV collaps
Premedication
Desensitisation
Avoidance
As a general rule,
a drug responsible for an allergic reaction
should not be reused
Unless there is an absolute need
and no alternative drug is available.
Premedication
Pretreatment with H1 antihistamines
should not be used
as they do not prevent anaphylactic shock
And may mask early signs.
However, in association with H1 antihistamines,
corticosteroids have been shown to be effective
in reducing reactions to radiocontrast media
Desensitisation
Desensitisation should be considered in patients
who have experienced IgE mediated allergic reactions to Penicillin
and who require penicillin for treatment of serious infections
(e.g ; bacterial endocarditis and meningitis)
Protocol using oral and parenteral routes have been proposed.
Should be performed under specialist supervision.
Oral administration is preferred because it is less likely to provoke
a life threatening reaction.
Desensitisation may occasionally be indicated for other antibiotics,
such as ;
sulphonamides, cephalosporins
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