Drug-Induced Anaphylaxis

Abstract

Drug-induced anaphylaxis can be a life-threatening condition occurring after drug intake by any route, including non-therapeutic exposure due to accidental contact. The most common culprit drugs are non-steroidal anti-inflammatory drugs and beta-lactam antibiotics. Other antibiotics, such as quinolones, are also becoming important elicitors. In the hospital setting, neuromuscular blocking agents and contrast media play an important role. In addition to specific immunological mechanisms (IgE-mediated), other non-immunological mechanisms may participate, including the generation of vasoactive mediators through the arachidonic acid metabolic pathway, direct stimulation of mast cells and the activation of other inflammatory cascades. Diagnosis of drug-induced anaphylaxis includes skin testing, in vitro testing in some instances, and very often requires drug provocation to search for alternatives or in some cases for diagnosis confirmation. Often, the diagnosis must be performed in the context of confounding agents. Factors contributing to the degree of severity include previous diseases (e.g. cardiovascular disease) and the intake of other drugs such as beta-blockers. In circumstances where the culprit drug must be administered, patients should be desensitised if possible. This may be carried out for drug-induced anaphylaxis caused by both immunological and non-immunological reactions, such as cross-intolerance to NSAIDs.