3. Drug hypersensitivity.
Most drug reactions are pharmacological reactions rather than hypersensitivity reactions. In assessing drug reactions, a detailed clinical history and careful documentation of reactions are most important. Elucidating the nature and time course (first versus subsequent exposure, immediate versus non-immediate) of a reaction can help to distinguish immune from non-immune hypersensitivity, as well as IgE-mediated from T cell-mediated allergy. Skin testing and in-vitro tests are of predictive value for only a limited group of IgE-mediated drug allergic reactions. Drug provocation challenges can be used to eliminate suspicion of a low-probability drug reaction, find a safe alternative to a proven or probable drug reaction, or as a means of desensitisation. If a patient taking an angiotensin-converting enzyme (ACE) inhibitor develops angioedema, the cause must be assumed to be the ACE inhibitor until proven otherwise.
Thien
Francis C K
FC
Department of Allergy Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia. F.ThienATalfred.org.au
D000799:Angioedema / Q000139:chemically induced; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D002983:Clinical Competence; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control; D007159:Immunologic Tests / Q000379:methods; D008487:Medical History Taking; D017410:Practice Guidelines as Topic; D012882:Skin Tests / Q000379:methods
D000806:Angiotensin-Converting Enzyme Inhibitors