Clinical Manifestations of Allergic Diseases: Drug Hypersensitivity

  • Benno Schnyder
  • Werner J. Pichler
Part of the Allergy Frontiers book series (ALLERGY, volume 4)

Drug allergies are those adverse drug reactions that are mediated by the specific immune system. Primary sensitization may involve T-cells alone or both T and B-cells with consecutive production of drug specific antibodies of different isotypes. It is mostly asymptomatic. However, there is evidence that primary sensitization may be induced not only by drug derived hapten-carrier-compounds, but also by cross-reactive allergens (e.g. viral infect, contact allergen etc.). Thus, an immune mechanism should also be considered in the case of reactions occurring on primary exposure to the causative drug.

The elicitation phase (or secondary response) can be divided into 4 categories corresponding to the type I–IV reactions described by Gell & Coombs. The vast majority of true drug allergies are thought to be either Ig-E (Type I) or T-lymphocyte-mediated (Type IV).

Drug allergy can cause a variety of diseases involving the skin, liver, kidney, lungs, and other organs. There is no single standardized diagnostic test that is able to confirm the immune mediated mechanism and identify the causative drug. Therefore, immune mediated drug hypersensitivity reactions and their causative drugs have to be recognized clinically by the constellation of exposure, timing, and pattern of organ manifestation. The diagnostic value of additional allergologic investigations is limited and their negative predictive value is not sufficient to exclude a drug allergy in the case of a suggestive history. Allergologic investigations comprise skin tests with immediate and late readings, the basophil activation test (BAT), and the lymphocyte transformation test (LTT). Provocation tests in order to identify the culprit drug are risky. The main target of allergologic investigations after a hypersensitivity reaction should be to enable doctors to prescribe further treatment with an appropriate risk/benefit ratio. Thus, such investigations may be reserved for finding an alternative drug therapy in situations where the incriminated drug(s) cannot easily be replaced.


Toxic Epidermal Necrolysis Drug Allergy Drug Hypersensitivity Basophil Activation Test Acute Generalize Exanthematous Pustulosis 


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Copyright information

© Springer 2009

Authors and Affiliations

  • Benno Schnyder
    • 1
  • Werner J. Pichler
    • 1
  1. 1.Division of AllergologyClinic for Rheumatology and Clinical Immunology/ Allergology, Inselspital, University of BernSwitzerland

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