Treatment of Drug Allergy

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Chapter: Essential pharmacology : Adverse Drug Effects

The offending drug must be immediately stopped. Most mild reactions (like skin rashes) subside by themselves and donot require specific treatment. Antihistamines (H1) are beneficial in some type I reactions (urticaria, rhinitis, swelling of lips, etc.) and some skin rashes.


TREATMENT OF DRUG ALLERGY

 

The offending drug must be immediately stopped. Most mild reactions (like skin rashes) subside by themselves and donot require specific treatment. Antihistamines (H1) are beneficial in some type I reactions (urticaria, rhinitis, swelling of lips, etc.) and some skin rashes. In case of anaphylactic shock or angioedema of larynx the resuscitation council of UK has recommended the following measures:

 

§  Put the patient in reclining position, administer oxygen at high flow rate and perform cardiopulmonary resuscitation if required.

§  Inject adrenaline 0.5 mg (0.5 ml of 1 in 1000 solution) i.m.; repeat every 5–10 min in case patient does not improve or improvement is transient. This is the only life saving measure. Adrenaline should not be injected i.v. (can itself be fatal) unless shock is immediately life threatening. If adrenaline is to be injected i.v., it should be diluted to 1:10,000 or 1:100,000 and infused slowly with constant monitoring.

§  Administer a H1 antihistaminic (chlorpheniramine 10–20 mg) i.m./slow i.v. It may have adjuvant value.

§  Intravenous glucocorticoid (hydrocortisone sod. succinate 100–200 mg) should be added in severe/recurrent cases. It acts slowly, but is specially valuable for prolonged reactions and in asthmatics.


 

Adrenaline followed by a short course of glucocorticoids is indicated for bronchospasm attending drug hypersensitivity. Glucocorticoids are the only drug effective in type II, type III and type IV reactions.

Drugs frequently causing allergic reactions

Drugs Frequently Causing Allergic Reactions

 

Penicillins           Salicylates

 

Cephalosporins   Carbamazepine

 

Sulfonamides      Allopurinol

 

Tetracyclines       ACE inhibitors

Quinolones         Methyldopa

 

Antitubercular drugs  Hydralazine

 

Phenothiazines    Local anaesthetics

 

 

Skin tests (intradermal, patch) or intranasal tests may forewarn in case of Type I hypersensitivity, but not in case of other types. However, these tests are not entirely reliable—false positive and false negative results are not rare.

 

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