Drug reactions

Abstract

Key Features: A large number of adult population suffer from undesired side effects to pharmaceutical products during the course of their lives. These reactions can be classified as expected or A-type reactions and unexpected or B-type reactions. The skin is a preferred target organ for B-type reactions. This type of skin reactions occur in 2-3% of hospitalized patients. Morbilliform drug rashes are the most often occurring skin reactions to drugs, constituting up to 90% of all reactions, followed by drug-induced urticaria, which constitutes about 6%. Severe cutaneous adverse reactions (SCAR) to drugs include: Anaphylaxis and angioedema. Photosensitivity. Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) Bullous drug reactions, including toxic epidermal necrolysis (TEN) Most often involved drugs are. Antibiotics-in particular β-lactam antibiotics, sulphonamids and fluoroquinolones. Antiretroviral drugs, such as abacavir and nevirapin. Allopurinol. Anticonvulsants. Contrast media. NSAIDs. Cytotoxic drugs such as platinum salt hyperse-nsitivity. Investigations about the functions of mediators and their effects in immediate type reactions such as anaphylaxis as well as signs and symptoms e.g., of angioedema improved our understanding of these reactions and revealed three main mediator systems: Histamine release. Derivatives of arachidonic acid. Bradykinin (angioedema) T-cells in delayed-type reactions and differently expressed cytokines improved our understanding of the pathophysiology of allergic reactions, and led to new diagnostic options and therapeutic concepts. Recently established animal models as well as investigations on the level of antigen-presenting cells may improve the ability to predict the immunogenicity of small molecular weight compounds. © 2010 Springer-Verlag Berlin Heidelberg.