TAILIEUCHUNG - Chapter 056. Cutaneous Drug Reactions (Part 8)

Allopurinol Together with sulfonamides and antiepileptics, allopurinol is one of the "usual suspects" that induce frequently mild maculopapular eruptions (in at least 3% of users) and may also cause more severe reactions including hypersensitivity/DRESS and SJS/TEN. Because of increasing utilization it is one of the most frequent causes of life-threatening reactions. Anti-HIV Medications In clinical trials, combinations of highly active antiretroviral treatments were frequently associated with ≥10% "drug eruptions." Two drugs, nevirapine and abacavir, have been associated with specific risks. Nevirapine has both a high risk of maculopapular eruptions and a very high risk (about 1 in 1000) of SJS or TEN. Progressive escalation. | Chapter 056. Cutaneous Drug Reactions Part 8 DRUGS OF SPECIAL INTEREST Allopurinol Together with sulfonamides and antiepileptics allopurinol is one of the usual suspects that induce frequently mild maculopapular eruptions in at least 3 of users and may also cause more severe reactions including hypersensitivity DRESS and SJS TEN. Because of increasing utilization it is one of the most frequent causes of life-threatening reactions. Anti-HIV Medications In clinical trials combinations of highly active antiretroviral treatments were frequently associated with 10 drug eruptions. Two drugs nevirapine and abacavir have been associated with specific risks. Nevirapine has both a high risk of maculopapular eruptions and a very high risk about 1 in 1000 of SJS or TEN. Progressive escalation of daily doses has been shown to decrease the risk of mild eruption but does not abrogate the risk of severe reactions. Abacavir is associated with a 4-5 risk of a hypersensitivity reaction which is remarkable because of the association of symptoms suggesting a type I reaction dyspnea diarrhea low blood pressure shock on rechallenge and signs of delayed hypersensitivity rash late onset hepatitis . The risk is lower in patients of African ancestry and strongly correlated with HLAB 5701. Penicillin The utilization rate of penicillin has decreased markedly since it has been the subject of many investigations and a model for drug allergy. Incidence of cutaneous reactions is about 1 . About 85 of cutaneous reactions to penicillin are morbilliform and about 10 are urticaria or angioedema. Anaphylaxis and serum sickness appear to be due to IgE antibodies in serum. Delayed reactions mainly maculopapular eruptions are much more common with aminopenicillins involving 4-7 of users. The question of crossreactivity between 0-lactam antibiotics and preventing the risk of anaphylaxis is discussed below Management of a Patient with a Drug Eruption . Nonsteroidal Anti-Inflammatory Drugs Most NSAIDs .

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