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Drug allergy, drug eruption

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If drugs have undesirable side effects, there may be a drug allergy behind them. This can lead to a drug eruption, for example: This is an allergic rash that often occurs when the body is overly sensitive to certain ingredients in the drug. In addition, the allergy can cause other different symptoms.

As a trigger for a drug allergy come in handy all Medication in question. However, some medicines (such as penicillin) are major solubilities more often a drug eruption or other allergic reactions than others.

Also how Using a drug has an impact on the risk of drug allergy: An allergic rash is caused by drugs that you use externally applies to the skin, much more often than a drug eruption or other allergic reaction to drugs that inside be used (e.g. by syringe into the vein or via the mouth).

How heavy If you are allergic to medication, it does not depend on the dose. Most often a drug allergy is involved Skin reactions connected - in addition to the drug eruption, this includes, for example:

In the case of a drug allergy, however, you can also other organs to be affected. Usually then the allergic reactions occur skin ahead of other reactions in the body - so they represent a kind early warning system represent.

In the case of a severe drug allergy, the most important treatment measure is: the drug suspected to be the trigger stop immediately! This subsides the allergic reaction - a drug eruption, for example, usually disappears within a few days. However, if you have a very strong drug allergy, it can take up to six weeks to heal.

There are also various options available for treating drug allergy Medication (Glucocorticoids, antihistamines) are available to relieve the drug eruption or other symptoms of the allergy.

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Anyone who has observed possible signs of a drug allergy or drug eruption or has been shown to be allergic to a drug is advised to

  • to inform the doctor or pharmacist if you are prescribed a new drug or buy it without consulting a doctor,
  • Pay attention to possible allergy-causing additives (such as preservatives) when using medication and
  • Carry an allergy pass with you in case of an emergency, in which the incompatible drugs are listed.

definition

The term Drug allergy refers to an increased or exaggerated (i.e. allergic) reaction of the immune system to certain ingredients of medication. A drug allergy is particularly common Drug eruption - this is an inflammatory rash from medication.

Such an allergic rash starts from the connective tissue of the vessels and can spread evenly over the whole body distributed or just on certain parts of the body be limited. Usually a drug eruption can go away. In addition to skin reactions, any other form of allergic reaction is possible with a drug allergy.

Virtually any drug can cause a drug allergy, with or without a drug eruption. However, drugs always contain so-called in addition to the active ingredient Auxiliary materials - such as fillers, stabilizers, flavorings and colorings. That is why a drug allergy is in some cases not on the active ingredient itself attributed, but to one other component.

frequency

There can be any medication behind a drug allergy - but the frequency with which the different drugs cause drug eruptions or other allergic reactions varies widely.

So join 0.7 to 10 percent of all penicillin treatments Penicillin allergy The allergic reaction can take any known form (e.g. rash, asthma, cardiac arrhythmias, low blood pressure, nausea, vomiting). On the other hand, other frequently used drugs - such as the heart-strengthening digoxin - lead extremely Rare to an allergy.

Also the type of application A drug has an influence on the allergic reactions in drug allergy: For example, the drug eruption or another allergic reaction to drugs is with theirs local Use on the skin essential more often than drugs that are injected into the vein or taken by mouth.

causes

A drug allergy with or without drug eruption (allergic skin rash) is caused by a Dysregulation and excessive defense reaction the immune system to certain substances contained in the medicine.

Basically you can all Medicines cause allergies - however, an allergic reaction to some drugs is much more likely than others. Any drug that triggers allergic reactions in the body can also cause inflammatory rashes on the skin or the adjacent mucous membranes. Especially locally Medicines applied - i.e. directly on the skin - lead to an existing drug allergy often to a drug eruption.

Drug allergy triggers with drug eruptions are in more inward The following active ingredients are often used:

  • Antiepileptic drugs: phenytoin
  • Psychotropic drugs: neuroleptics and tricyclic antidepressants
  • Sleeping pills (barbiturates)
  • Painkillers and anti-rheumatic drugs: pyrazolones, oxicams, gold supplements and D-penicillamine
  • Muscle relaxants: suxamethonium
  • Antibiotics and chemotherapy drugs: penicillins, cephalosporins, chloramphenicol, sulfonamides, nitrofurantoin
  • Anti-tuberculosis drug: isoniazid
  • Antifungal: Amphotericin B
  • Antimalarials: quinine
  • Thyroid drugs: iodine, thiouracils, perchlorate, mercaptoimidazoles
  • Hormones: insulin
  • Blood substitutes: dextran, gelatin
  • Medicines with an effect on the heart and circulation: hydralazine, procainamide, methyldopa

The causes of a drug allergy with drug eruption are local Use the following active ingredients in particular:

A drug allergy can also go through Preservatives which may be contained in a medicinal product. These include benzalkonium chloride, parabens mix and thimerosal.

Symptoms

The symptoms caused by a drug allergy affect the skin in 80 percent of cases: it often develops as an allergic reaction to medication Drug eruption - an inflammatory allergic rash - on large areas of the skin. In addition, there may be an allergy to drugs other symptoms cause on the skin - such as:

  • Redness
  • Swelling
  • watery wheals
  • Edema

The drug eruption and other skin reactions can occur on the skin, mucous membranes, hair, sweat and sebum glands or on the nails. Usually they are accompanied by itching. The skin changes as a result of a drug allergy can be very differently fail - Examples of skin allergy symptoms are:

  • Hives (urticaria), Quincke's edema
  • patchy looking inflammatory rash with small nodules (maculopapular rash)
  • EEM-like exanthema (EEM = erythema exudativum multiforme: skin disease characterized by peeling skin, in which water- or blood-filled blisters form)
  • photoallergic dermatitis
  • blotchy reddening of the skin (purpura)
  • Contact dermatitis
  • Scalded skin syndrome (Lyell's syndrome or toxic epidermal necrolysis, TEN)
  • blistering rash that starts with fever and poor general condition, first on the mucous membranes, then spreading to the skin and causing a map-like inflammatory rash there (so-called Stevens-Johnson syndrome)
The first allergic reaction to a drug is usually quite weak. At repeated However, the symptoms of drug allergy typically increase in contact. In addition to the skin reactions, the drug allergy can then other symptoms cause - for example:

The Severity drug allergy can vary greatly. How severe an allergic reaction to medication is, however, depends Not on their dose: Even low-dose drugs can cause a severe drug eruption or other clear symptoms in an allergy sufferer. Most of the time, however, a drug allergy runs Not serious. Exceptions of this form the Stevens-Johnson Syndrome and the Lyell syndromethat can be life threatening.

diagnosis

In order to diagnose a possible drug allergy or drug eruption (= inflammatory skin rash caused by drugs), it is helpful to stop the drug presumably responsible for the allergy: If the symptoms disappear after stopping the drug, this is a clear indication of an allergy.

If someone several Drug allergy diagnosis is difficult. The reason: It is seldom possible to infer from the type of allergic reaction to a particular drug. The drug eruption, for example, is not even very different from rashes of other origin.

In addition, it can happen that a drug eruption caused by the drug allergy - or another skin change - occurs over time Not coincides with the first use of a drug. The connection between taking the drug and the symptoms of drug allergy can also go undetected if the allergic symptoms initially occur persistafter they stop taking the medicine.

It can also show signs of drug allergy resemble other diseases. It is therefore sometimes difficult to correctly assign a drug eruption and other reactions triggered by a drug allergy - and it can happen that an allergy remains undetected as the cause.

If a skin rash develops in the course of drug treatment, it is always advisable to consult a doctor (allergist) who is familiar with allergies to clarify whether it is a drug eruption: If a drug allergy remains undetected, the causal agent can be re-applied Drug severe allergic reactions arise.

However, a classic allergy test on the skin is only partially suitable for diagnosing a drug allergy: it can only be used to detect an allergic rash caused by a few drugs such as antibiotics and anti-inflammatory drugs (especially cortisone).

therapy

In the case of a serious drug allergy with or without drug eruption (allergic skin rash), one thing is initially important for therapy: right away the drug that might be the triggerdrop!

If you various However, taking medication at the same time or applying it topically may under certain circumstances difficult be able to find the drug that caused the drug allergy.

There is also the possibility of the acute allergic reaction in the case of a drug allergy Medication to treat. As a rule, you will be given a glucocorticoid to treat the symptoms of the allergy and - if you have a drug eruption or other skin reactions with itching - an antihistamine. If the drug allergy causes severe allergic reactions, therapy should be given if necessary intensive care measures required.

course

forecast

One caused by a drug allergy Drug eruption (= allergic rash from medication) usually shows one favorable courseafter getting the triggering medication discontinued has: The rash usually heals within a few days (at most within a week).

The prognosis is somewhat less favorable if very strong allergic reactions occur as a result of the drug allergy: In this case, it can take up to six weeks for final healing.

Complications

A drug allergy with or without a drug eruption can come with various Complications be connected when the allergic reaction heavy fails and no adequate treatment is given.

A drug eruption as the first symptom of a drug allergy can indicate that the Involvement of other organs threatens:

  • Here can only a Organ be affected,
  • but it can also be a so-called generalized response occur in the several Organs are affected.

Generalized In contrast to localized skin reactions, reactions are mostly in the case of a drug allergy more serious. The most severe form is anaphylactic shock, which is a life-threatening complication.

Examples of other generalized allergic reactions as a result of a drug allergy are:

Stevens-Johnson Syndrome and Lyell Syndrome

Other possible complications of drug allergy without medical attention life threatening Stevens-Johnson syndrome and Lyell syndrome are:

  • Stevens-Johnson Syndrome
    Typical of this drug reaction are initially: high fever, a very poor general condition and a blistered rash on the mucous membranes. This can affect the conjunctiva of the eye, the vaginal mucosa, the mucous membrane of the urinary bladder and the rectum as well as the oral mucosa.
    In the further course the rash can spread to the skin and cause a map-like rash (skin rash) there.
  • Lyell syndrome (toxic epidermal necrolysis, TEN)
    This drug allergy-related reaction is also called Scalded Skin Syndrome known: the epidermis becomes inflamed over a large area, accompanying the death of the skin (necrosis); large areas peel off and bubbles form. The affected skin areas resemble a skin burn.
    In addition to skin reactions, there are often other severe reactions, such as bronchopneumonia or kidney failure.

Medicines that can cause Stevens-Johnson syndrome or Lyell syndrome in drug allergy include:

Prevent

You can have a drug allergy or a drug eruption (skin rash) Not prevent, as the body is generally allergic to allMedicines can develop.

If you have previously developed a drug eruption or other allergic reaction to medication, it is advisable to do so always to speak towhen a doctor prescribes a new drug for you. In the case of self-medication - i.e. if you buy and take prescription-free medication without medical advice - it is recommended that you inform the pharmacist about the drug allergy. If there is a known allergy to preservatives in drugs, only drugs without these additives should be used as a preventive measure.

Also, if you have a drug allergy, it is important to have one Allergy pass to carry with you, in which the incompatible drugs are listed: This may be in emergency situations in which you may not be available (e.g. when being admitted to a hospital) life saving be.

Swell:

Online information from the German Allergy and Asthma Association V. (DAAB): www.daab.de (access date: 30.3.2021)

Online information from the Pschyrembel: www.pschyrembel.de (as of 2016)

Guideline of the German Society for Allergology and Clinical Immunology e.V. (DGAKI): Allergological diagnosis of hypersensitivity reactions to drugs. AWMF guidelines register No. 061/021 (as of December 2014)

Dirschka, T., Hartwig, R., Oster-Schmidt, K. (Ed.): Clinical Guide Dermatology. Urban & Fischer, Munich 2010

Aktories, K., Förstermann, U., Hofmann, F.B., Starke, K .: Repetitorium General and Special Pharmacology and Toxicology. Urban & Fischer, Munich 2009

Pezzutto, A., et al .: Pocket Atlas of Immunology. Thieme, Stuttgart 2006

Störiko, A .: Allergies. Falken, Niedernhausen 2001

Last content check:16.03.2016
Last change: 30.03.2021