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Treatment of Drug Allergy Patients |
Improper use of medication can easily cause allergic reactions, ranging from mild symptoms such as hives, inflammation, and skin redness to severe cases like anaphylactic shock, which can lead to death.
There are 10 common types of conditions associated with drug allergies:
Hives: This is often the mild and initial clinical manifestation of most drug allergy cases. Any medication can cause hives, but antibiotics, vaccines, serums, anti-inflammatory painkillers, and antipyretics are more frequently involved. After taking medication (which can happen quickly within 5-10 minutes or slowly over several days), patients may experience flushing, itching, and the appearance of wheals on the skin. Severe cases may involve difficulty breathing, abdominal pain, joint pain, dizziness, nausea, headache, fatigue, and high fever…
Acute hives typically present with increased wheals that disappear quickly and reappear just as fast, lasting under three weeks. Daily recurrent hives lasting more than three weeks indicate a transition to chronic hives.
Angioedema: This is a localized swelling condition that may be caused by antibiotics, vaccines, serums, or non-steroidal anti-inflammatory drugs. Swelling usually appears rapidly after taking medication in thin-skinned areas such as the lips, neck, around the eyes, abdomen, limbs, and genitalia. The size of angioedema can be substantial, sometimes as large as a hand; if near the eyes, it can cause them to narrow, and if on the lips, it can lead to significant swelling and distortion. The skin color in the swollen area is typically normal or slightly pink and may sometimes accompany hives. If angioedema occurs in the throat or larynx, it can cause breathing difficulties; in the intestines or stomach, it can cause abdominal pain; and in the brain, it may lead to headaches…
Anaphylactic Shock: This is a severe allergic reaction that can be life-threatening. Several types of medications can induce anaphylactic shock, including antibiotics, vaccines, serums, non-steroidal anti-inflammatory drugs, liver extracts, certain vitamins, anesthetics, and iodine-based contrast agents…
The clinical picture of anaphylactic shock is quite varied, but it typically occurs within seconds to 20-30 minutes after taking medication, beginning with unusual sensations (numbness of the lips, tongue, restlessness, fear…). This is followed by the rapid onset of symptoms such as difficulty breathing, rapid weak pulse, dropping blood pressure (sometimes unmeasurable), widespread itching, abdominal cramps, involuntary urination and defecation; in acute cases, patients may become comatose, experience asphyxiation, arrhythmias, cardiac arrest, and even death within minutes.
Agranulocytosis: This condition can appear after patients use medications such as sulfonamides, high-dose penicillin, streptomycin, chloramphenicol, pyramidon, and analgin. The typical clinical picture includes sudden high fever, fatigue, rapidly declining health, rashes resembling measles or hemorrhagic spots, necrotizing ulcers of the mucous membranes in the mouth, throat, and genital area, pneumonia, venous thrombosis, and hemorrhagic infections, which can easily lead to death.
Serum Sickness: This is a common allergic drug reaction primarily caused by antibiotics like penicillin, ampicillin, and streptomycin, among others. Symptoms usually develop between the second day and the fourteenth day after medication use, including fatigue, loss of appetite, insomnia, nausea, joint pain, swollen lymph nodes, high fever (38-39 degrees Celsius), enlarged liver, and generalized hives. If detected early and the medication is stopped promptly, these symptoms will gradually resolve.
Contact Dermatitis: Essentially a eczema-like reaction, the primary lesions are vesicles accompanied by redness, itching, and swelling of the skin, progressing through various stages. Contact dermatitis can appear quickly within a few hours, on average within a few days, or sometimes weeks after using or coming into contact with medication.
Common culprits causing contact dermatitis include topical medications, substances capable of diffusing in the environment (such as antibiotic ointments, anti-inflammatory creams, skin protectants, direct contact with medications during pharmaceutical manufacturing, and antibiotic aerosols). The condition can also arise from using injected, oral, or aerosolized medications.
Exfoliative Erythema: Medications that commonly cause exfoliative erythema include penicillin, ampicillin, streptomycin, sulfonamides, chloramphenicol, tetracycline, tranquilizers, pain relievers, and antipyretics. Symptoms typically appear 2-3 days, averaging 6-7 days, and sometimes 2-3 weeks after medication use. Patients experience flushing and itching all over, high fever, gastrointestinal disturbances, and widespread red rashes, with white scales on the skin; fissures may develop in the creases of the extremities, sometimes leading to secondary infections with pus.
Erythema Multiforme: This condition begins a few days after taking medication with symptoms including mild fever, fatigue, joint pain, swollen lymph nodes, and a burning sensation throughout the body, with round wheals similar to hives appearing on the skin, raised edges, and slightly red centers that are somewhat indented and wrinkled. In addition to wheals, there may be vesicles and bullae surrounded by a red halo; it can also involve mucosal lesions in natural cavities and internal organ damage (heart, liver, kidneys…), with recurrent episodes; in severe cases, it can be fatal.
Stevens-Johnson Syndrome (erythema multiforme with vesicles): Often caused by antibiotics such as penicillin, ampicillin, streptomycin, and tetracycline; slow-acting sulfonamides, tranquilizers, and non-steroidal anti-inflammatory drugs. Symptoms develop within hours to 10-15 days after medication intake, including fatigue, widespread itching, a burning sensation, high fever, red rashes, and vesicles on the skin, with necrotizing ulcers of the mucous membranes in natural cavities (mouth, eyes, nose, ears, anus, genitals, urinary tract) and possible liver and kidney damage, which can be fatal in severe cases.
Lyell’s Syndrome (toxic epidermal necrolysis): This is the most severe form of drug-induced skin toxicity caused by medications such as slow-acting sulfonamides, penicillin, ampicillin, streptomycin, tetracycline, analgin, and phenacetin. The disease progresses from a few hours to several weeks after medication use. Patients present with profound fatigue, insomnia, high fever, widespread itching, and red patches on the skin, sometimes with petechiae; a few days later, or sometimes sooner, the epidermis separates from the underlying skin, peeling off in sheets with minimal contact, resembling full-body burns. Patients may suffer from necrotizing lesions in natural cavities, pneumonia, pleuritis, hepatitis, and nephritis, and their condition is often very severe, leading quickly to death.
Dr. Le Van Khang (Health & Life)
