PSEUDOALLERGY &

DRUG ALLERGY
Ika Puspita Dewi
 Allergy
Hypersensitivity Disorders caused by immune
responses
Allergy
Allergy or atopy combined immediate and late-
phase reactions
Drug reactions allergy
 Pseudoallergy
Reactions that clinically resemble allergic reactions but
lack an immune basis are referred to as pseudoallergic.
Include almost the entire range of immediate hypersensitivity
clinical patterns.

Allergy vs Pseudoallergic reactions reactions where the components of

the immune system are used in exactly the same way, but
Pseudoallergy without the learning response by T cells and generally without
the much greater danger that true immunologic sensitization
implies.
Idiopathic reactions
The pathophysiology of pseudoallergic reactions is generally
unknown, but indicators of immune activation are not seen when
they occur
 Drug small molecules how to elicit immune
response?
Haptenation hypothesis
Drug covalently bound to a normal self protein immune
response
Nonreactive drug becomes chemically reactive during
Drug Allergy metabolism and then covalently binds to self-proteins

Antigens Pharmacologic interaction (p-i) hypothesis drug (or

metabolite) directly binds to the T-cell receptor initiating an
immune response T-cells are directly activated (despite not
interacting with antigen presenting cells)
The metabolism of the drug often plays a critical role skin
keratinocytes are a site of drug metabolism clinical manifestation
on the skin
 The most common of the life-
threatening drug reactions are
predominately cutaneous,
including Stevens-Johnson
Clinical syndrome (SJS), toxic
epidermal necrolysis (TEN),
Manifestations and drug reaction with
eosinophilia and systemic
symptoms (DRESS) or drug-
induced hypersensitivity
syndrome (DIHS)
Anaphylaxis
PROBLEMATIC
DRUG
CLASSES AND
TREATMENT
OPTIONS
 Beta lactam Penicillins,
Cephalosporins, Carbapenems,
Monobactam
The most common reactions are
maculopapular and urticarial
eruptions to anaphylactic
reactions

-Lactam
Antibiotics
 Sulfonamides are compounds that contain a sulfonamide moiety
(ie, SO2NH2)
Sulfonamide antibiotics sulfonamides, trimethoprime, SMZ-
TMP
Sulfonamide Nonarylamine sulfonamides furosemide, thiazide diuretics,
sulfonylureas, and celecoxib
Antibiotics The sulfonamide antibiotics are significant because they account
for the largest percentage of antibiotic-induced toxic epidermal
necrolysis and Stevens-Johnson syndrome cases
Stevens-
Johnson
Syndrome
(SJS)
Stevens- Johnson Syndrome (SJS)
 Three types of reactions occur:
bronchospasm with
rhinoconjunctivitis,
urticaria/angioedema, and
anaphylaxis
Aspirin and Two specific conditions
Nonsteroidal aspirin-exacerbated respiratory
disease (AERD) and chronic
Anti- idiopathic urticaria
AERD may include asthma,
Inflammatory rhinitis with nasal polyps, and
aspirin sensitivity.
Drugs Chronic idiopathic urticaria may
also be seen with
aspirin or NSAID-induced
pseudoallergic reactions
 Opiates (morphine, meperidine, codeine, hydrocodone,
and others) stimulate mast cell release directly, resulting in
pruritus and urticaria with occasional mild wheezing
Chemotherapy agents (taxanes, platinum compounds,
asparaginases, and epipodophyllotoxin) mild (flushing and
rashes) to severe (dyspnea, bronchospasm, urticaria, and
hypotension)
Insulin protein can induce IgE sensitivity directly
Others anaphylaxis. Adverse reactions to insulin also include erythema,
pruritus, and indurations, which are usually transient and may
be injection site related.
Anticonvulsants phenytoin, carbamazepine, phenobarbital,
and primidone, lamotrigine, oxcarbazepine, felbamate, and
zonisamide) can cause a life-threatening syndrome with
symptoms including fever, a maculopapular rash, and evidence of
systemic organ involvement
 Antihistamines preventing the effects of histamine
Loratadine, Cyproheptadiene, Cetirizine, Chlorpheniramine,
Prometazine,
Corticosteroids
Epinephrine
DRUG Immunotherapy allergen OMALIZUMAB, Vaccine
ALLERGY desensititasi

TREATMENT &
MANAGEMENT

http://pionas.pom.go.id/ioni/bab-3-sistem-saluran-napas-0/34-antihistamin-
hiposensitisasi-dan-kedaruratan-alergi
http://www.aaaai.org/conditions-and-treatments/allergies/drug-allergy
Antihistamine
Antihistamine
Corticosteroids
Drug
Diagnosis
Allergic Rhinitis
 Rhinitis (allergic rhinitis) an inflammation of the nasal
membranes that is characterized by sneezing, nasal congestion,
nasal itching, and rhinorrhea, in any combination
 Signs and symptoms of allergic rhinitis include the following:
Sneezing
Itching: Nose, eyes, ears, palate
Rhinorrhea
Postnasal drip
Congestion
Headache
Symptoms Earache
Tearing
Red eyes
Eye swelling
Fatigue
Drowsiness
Malaise
 Laboratory tests used in the diagnosis of allergic rhinitis include the
following:
Allergy skin tests (immediate hypersensitivity testing): An in vivo
method of determining immediate (IgE-mediated)
hypersensitivity to specific allergens
Fluorescence enzyme immunoassay (FEIA): Indirectly measures
the quantity of immunoglobulin E (IgE) serving as an antibody to a
Diagnosis particular antigen
Total serum IgE: Neither sensitive nor specific for allergic rhinitis,
but the results can be helpful in some cases when combined with
other factors
Total blood eosinophil count: Neither sensitive nor specific for the
diagnosis, but, as with total serum IgE, can sometimes be helpful
when combined with other factors
 The management of allergic rhinitis consists of the following 3
major treatment strategies:
Environmental control measures and allergen avoidance: These
include keeping exposure to allergens such as pollen, dust mites,
and mold to a minimum
Pharmacologic management: Patients are often successfully
Treatment treated with oral antihistamines, decongestants, or both; regular
use of an intranasal steroid spray may be more appropriate for
patients with chronic symptoms
Immunotherapy: This treatment may be considered more strongly
with severe disease, poor response to other management options,
and the presence of comorbid conditions or complications;
immunotherapy is often combined with pharmacotherapy and
environmental control
Food Allergy
 An allergy occurs when your bodys natural defenses overreact to
exposure to a particular substance, treating it as an invader and
sending out chemicals to defend against it.
Symptoms of a food allergy can range from mild to severe a
food that triggered only mild symptoms on one occasion may
cause more severe symptoms at another time.
The most severe allergic reaction is anaphylaxis
Food Allergy Most food-related symptoms occur within two hours of ingestion;
often they start within minutes. In some very rare cases, the
reaction may be delayed by four to six hours or even longer.
Delayed reactions are most typically seen in children who develop
eczema as a symptom of food allergy and in people with a rare
allergy to red meat caused by the bite of a lone star tick
Once a food allergy is diagnosed, the most effective treatment is
to avoid the food.
 While any food can cause an adverse reaction, eight types of food
account for about 90 percent of all reactions:
Eggs
Milk
Peanuts
Causes Tree nuts
Fish
Shellfish
Wheat
Soy
 Symptoms of an allergic reaction may involve the skin, the gastrointestinal
tract, the cardiovascular system and the respiratory tract.
Vomiting and/or stomach cramps
Hives
Shortness of breath
Wheezing
Repetitive cough
Shock or circulatory collapse

Symptoms Tight, hoarse throat; trouble swallowing

Swelling of the tongue, affecting the ability to talk or breathe
Weak pulse
Pale or blue coloring of skin
Dizziness or feeling faint
Anaphylaxis, a potentially life-threatening reaction that can impair breathing
and send the body into shock; reactions may simultaneously affect different
parts of the body (for example, a stomachache accompanied by a rash)