Abstract
Drug hypersensitivity reaction (DHR) is defined as an immunologically mediated response to a pharmacology agent. Some reactions require prior sensitization and some do not. The interactions between different drugs and the immune system occur by different mechanisms leading to variable clinical features. Some reactions are simple and do not alter patient quality of life. Some are life threatening and require immediate recognition and appropriate therapy. Confirming the diagnosis of DHR is often challenging. The environment in the Intensive care units (ICU) is considered high risk place for DHR development as it offers most of the risk factors. In this review, we offer a delicate combined approach that allows an accurate diagnosis of most of the DHRs encountered in the ICU.
Highlights
Adverse drug reactions are one of the leading causes of morbidity and mortality in healthcare
Commercial kits are available in order to detect susceptible Human Leukocyte Antigen (HLA) types to avoid using any drug that is linked to a severe Drug hypersensitivity reaction (DHR) in that particular HLA (HLA-B*5701 for Abacavir and HLA-B*1502 typing in Han Chinese) [20] (Table 4)
Drug reaction is not always due to drug allergy, and it demands detailed past medical history
Summary
Adverse drug reactions are one of the leading causes of morbidity and mortality in healthcare. DHR is a broader term and it involves reactions that mount a cascade of immune response with or without Ig-E pathways and involves T cell activations. These two terms have been used in the literature interchangeably. DHR may cause serious reactions, including anaphylaxis and death. Risk factors for developing DHR are host or drug related (Table 1). The presence of atopy is not considered a risk factor for DHR except for Penicillin anaphylaxis [5] and allergic reactions induced by Latex and Radio Contrast Media (RCM). Other treatment modalities may include systemic steroids, antihistamines, broad spectrum antibiotics, and treatment in burns units
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