Drugs allergy case presentation by Mai Bashir.pdf

Introduce Drug Allergy, and management in ER department

1. DRUGS ALLERGY
CASE PRESENTATION By Mai Bashir

2. INTRODUCTION
❖Drug allergy is the reaction of immune system to a medicine . Is may due to herbal
or any substance .
❖The most common symptoms are hives, rash or fever , and even lead to anaphylaxis
.
❖there is different 3 ; drug side effects
Drug allergy drug toxicity

3. CASE
pt 33 years old female , no significant past medical history , not smoker .
Come, no known drug allergies . Pt present with a rash, itching , swelling of lips and
face started 3 hrsafter taking amoxicillin \or NSAIDs .
Onset suddenly begin .
Drugs details amoxicillin dose , is it first tmeor not ..etc.
test :
▪skin prick test IgEincrease

4. ❖Anaphylaxis is a generalized immunological condition of sudden onset,
which develops after exposure to a foreign substance. The mechanism may:
❖• Involve an immunoglobulin E (IgE)-mediated reaction to a foreign
protein (stings, foods, streptokinase) or to a protein–hapten conjugate
(antibiotic).
❖• Be complement-mediated ( blood
products).
❖• Be unknown (aspirin )

5. THE MECHANISM
mast cells and basophils release mediators
(eghistamine, prostaglandins, thromboxanes, platelet-activating factors,
leukotrienes), producing clinical manifestations. Angio-oedema caused
by angiotensin-converting enzyme (ACE) inhibitors and hereditary angiooedema
may present in a similar way to anaphylaxis.

6. COMMON CAUSES
• Drugs and vaccines (egantibiotics, streptokinase, suxamethonium,
aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), IV contrast
agents).
• Hymenoptera (bee/ wasp) stings.
• Foods (nuts, shellfish, strawberries, wheat).
• Latex.

7. CLINICAL FEATURES
onset is usually in minutes/ hours.
Sxmore severe in pt withhistory of ischaemicheart disease (IHD) or asthma may have especially
severe features.
• Respiratory Swelling of the lips, tongue, pharynx, and epiglottis may
Lead to obstruction. Lower airway involvement —dyspnoea, wheeze, chest tightness,
hypoxia, and hypercapnia.
• Skin , erythema, urticaria, and angio-oedema.
• Cardiovascular Peripheral vasodilatation and ivascular permeability
cause plasma leakage from the circulation, withintravascular volume,
hypotension, and shock. Arrhythmias, ischaemicchest pain, and ECG
changes may be present.
• Gastrointestinal (GI) tract Nausea, vomiting, diarrhoea, abdominal
cramps.

8. TREATMENT
• Discontinuof suspected factor (egdrug).
Remove stings by scraping them carefully away from skin.
• Give 100% O2 and IM adrenaline as indicated.
• Open and maintain airway. If upper airway oedema is present, get
specialist senior help immediately. Emergency intubation or a surgical
airway and ventilation may be required.
• In profound shock or immediately life-threatening situations, give CPR/

9. If there is no response to adrenaline, consider glucagon 1–2mg intramuscular
(IM)/ IV every 5min (especially in patients taking β-blockers).
• Give a β2-agonist (egsalbutamol 5mg) nebulized with O2 for
bronchospasm, possibly with the addition of nebulized ipratropium
bromide 500mcg.
• Give IV fluid if hypotension does not rapidly respond to adrenaline.
Rapid infusion of 1–2L IV 0.9% saline may be required, with further
infusion according to the clinical state.
• Antihistamine H1 blockers (egchlorphenamine 10–20mg slow IV) and
H2 blockers (egranitidine 50mg IV) are commonly given. They are
second-line drugs that, with hydrocortisone 100–200mg slow IV, may
reduce the severity/ duration of symptoms.
• Admit/ observe after initial treatment: prolonged reactions

10. Report anaphylactic reactions related to drugs/ vaccines to the Committee
on Safety of Medicines.

13. Thank you