Drug Allergy

450 Pages·2009·2.11 MB·English

This latest edition of Drug Allergy, indisputable reference source for drug allergies, is a response to
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It includes references to the latest publications available in the medical literature. Conceived and
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Phadia AB. P O Box 6460, SE-751 37 Uppsala, Sweden
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Daniel VERVLOET - Michel PRADAL - Joëlle BIRNBAUM
- Marie-Christine KOEPPEL
Department of Pneumology and Allergy
Department of Dermatology
Hôpital Sainte Marguerite
Hôpital Nord
Université de la Méditerranée
Marseille - France
DRUG ALLERGY
Drug Allergy •1
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Copyright Phadia AB
Editorial coordination and bibliography : Dr David A. Lévy
Editorial assistant : Sandrine Fidalgo
Layout : Françoise Calley
Printed in France by Corlet imprimeur.
Editions de Condé
103 rue de Sèvres
75006 Paris
www.editions-de-conde.fr
2• Drug Allergy
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TABLE OF CONTENTS
PREFACE.........................................................................................................5
INTRODUCTION...............................................................................................6
I• DRUGS AND SUBSTANCES USED DURING ANESTHESIA
AND INTENSIVE CARE ................................................................................7
II• ANALGESICS AND ANTI-INFLAMMATORY DRUGS............................................43
III• ANTIBIOTICS AND ANTIPARASITE DRUGS,
ANTIVIRAL AND ANTIFUNGAL DRUGS ........................................................57
IV• CHEMOTHERAPY DRUGS AND IMMUNO-SUPPRESSORS.................................139
V• DRUGS USED IN CARDIOLOGY AND VASCULAR DISORDERS...........................211
VI• DYES, PRESERVATIVES, ANTISEPTICS.........................................................261
VII• PRODUCTS USED IN DIALYSIS ..................................................................289
VIII•DIAGNOSTIC AGENTS..............................................................................295
IX• HORMONES AND ENZYMES......................................................................311
X• SERA AND VACCINES...............................................................................333
XI• VITAMINS.............................................................................................359
XII• GASTROENTEROLOGY..............................................................................371
XIII•BIOLOGICAL AGENTS...............................................................................379
XIV• DRUGS USED IN NEUROLOGY AND RHEUMATOLOGY....................................407
XV• MISCELLANEOUS.....................................................................................435
INDEX.........................................................................................................444
Drug Allergy •3
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PREFACE
T he first edition of this work was based on Dr. Michel Pradal’s
thesis, one of the requirements for his medical degree, which
he obtained in 1987. Now, twenty years later, we have produced
the forth edition of this work. Our aim, as in the previous editions,
is to help doctors, especially allergists, diagnosis drug allergy - a
constantly expanding field - in a practical way. For each drug
known or suspected of being responsible for allergic reactions, the
incidence, clinical manifestations, diagnostic methods and
management are described, with a few relevant references at the
end of each section.
Many new drugs have appeared on the market during the last
decade, biological agents for example, and they are included in
this present edition.
This work was achieved thanks to the participation of Doctors
Michel Pradal, Joëlle Birnbaum, and Marie-Christine Koeppel.
I also want to thank Dr. David A. Levy for his help with the
bibliography research and for editing the manuscript.
I hope that doctors will find the information in this book useful in
their practice.
Daniel Vervloet
Drug Allergy •5
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INTRODUCTION
A
dverse drugs reactions involve two different mechanisms:
allergic and non-allergic reactions. Misclassification is
frequent, and the word “allergy” is often misused. Twenty years
ago, very few sessions at international allergy meetings focused on
drug allergy. However, during the past decade a tremendous
amount of work has been done on this subject, including
epidemiological studies, immunological research on IgE and non-
IgE mechanisms, as well as the development of drug allergy and
drug vigilance networks.
However, it is still difficult for the clinician to manage a patient
suffering from drug allergy. The incidence of these reactions, risk
factors, mechanisms, clinical manifestations, diagnostic methods
and management may differ from drug to drug and from patient
to patient. As I mentioned 10 years ago in the Third Edition of this
book “as drug allergy is concerned, there is one general rule, i.e.,
there are no general rules”. That is why in this book we have tried
to develop for each drug specific rules to follow to arrive at a cor-
rect diagnosis and then the best way to manage the patient.
6• Drug Allergy
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I
DRUGS USED FOR ANESTHESIA
AND INTENSIVE CARE
Drug Allergy - chapter I•7
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Alfentanil, Fentanyl, Remifentanil,
Sufentanil
Major morphinomimetic analgesics, used in anesthesia.
y Incidence
Extremely rare.
y Risk factors
Previous sensitization to another phenylpiperidine drug.
y Clinical manifestations
•General
The clinical manifestations of anaphylaxis are classified into five grades of severity:
-Grade I: mild, self-limiting reactions, e.g., isolated skin symptoms;
-Grade II: moderate reactions quickly responding to therapy, e.g., hypotension, bronchospasm or
multivisceral symptoms;
-Grade III: severe reactions requiring prolonged treatment, e.g., anaphylactic shock;
-Grade IV: cardiac and respiratory arrest;
-Grade V: death
• Cutaneous: application site reactions including itching, erythema, papules and oedema; diffuse
rash.
y Diagnostic methods
Skin tests:Concentration normallynon-reactive in practice.
•Alfentanil(0.5mg/ml): Prick test: undiluted (0.5mg/ml)
Intradermal tests 1/10 (50µg/ml)
•Fentanyl (0.05 mg/ml): Prick test: undiluted (0.05 mg/ml)
Intradermal tests: 1/10 (5µg/ml)
•Remifentanyl(0.05 mg/ml): Prick test: undiluted (0.05 mg/ml)
Intradermal tests: 1/10 (5µg/ml)
•Sufentanyl (0.005 mg/ml): Prick test: undiluted (0.005 mg/ml)
Intradermal tests: 0.5µg/ml
Dilution series is used starting with a 1/10,000 dilution and increasing the concentration up to the
highest level that usually does not produce a reaction in non-allergic individuals.
y Mechanisms
These drugs apparently do not induce non-specific mediator release from mast cells.
IgE-mediated hypersensitivity, as indicated by positive skin-tests is restricted to fentanyl.
y Management
Avoidance.
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No cross-reactivity between the different opioid subclasses phenanthrenes, phenylpiperidines, and
diphenylheptanes.
References
Muijsers RB, Wagstaff AJ. Transdermal fentanyl: an updated review of its pharmacological and therapeutic effi-
cacity in chronic cancer pain control. Drugs 2001;61:2289 – 2307.
Bennett MJ, Anderson LK, Mc Millan JC, et al. Anaphylactic reaction during anaesthesia associated with positive
intradermal skin test to fentanyl. Can Anaesth Soc. J 1986;33:75-8.
Drug Allergy - chapter I•9