Abstract
Drug reactions that lead to an intensive medical response represent a significant medical problem. These reactions can be due to known pharmacologic activities of a drug, activation of the immune system, or other mechanisms. Reactions that involve the immune system account for only 10% of cases but can be dramatic and life-threatening [1, 2]. The cost of drug reactions with an immunologic basis is approximately $3 to $13 billion/year, when extrapolated from estimates of the cost for all drug reactions in the United States [1, 3]. Reactions that involve immunologic mechanisms often are described as “allergic.” The word allergic is used to describe reactions that are mediated through the IgE class of antibodies. The term immunologic drug reaction includes any immune reaction that involves specific recognition by the immune system (via antibodies or the T-cell receptor) and thus includes IgE-mediated reactions [4]. The term often is used to refer to drug reactions that mimic allergic reactions (e.g., release of proinflammatory mediators) but occur via activation of the immune system in a fashion that is independent of antibody or specific receptors [4–7]. The term idiosyncratic refers to an uncharacteristic response to a drug that is qualitatively different from its pharmacologic activity and that is not immunologic in mechanism. These reactions may be genetically based and related to metabolic or enzyme deficiencies [4, 5].
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Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition
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I
Evidence obtained from at least one properly randomized controlled trial.
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II-1
Evidence obtained from well-designed controlled trials without randomization.
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II-2
Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
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II-3
Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.
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III
Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.
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Stitt, J.M., Dreskin, S.C. (2017). Toxicant-Induced Immunological Reactions. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_129
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DOI: https://doi.org/10.1007/978-3-319-17900-1_129
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