Drug allergy risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

Drug Allergy

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Overview

There are known risk factors for the development of drug allergies. Some are based on the patient and include; female gender, being young or middle aged, genetics, presence of certain viral infections (HIV and EBV), and history of atopy or prior drug allergies. Other factors are based on the quality of the drug, and include; high molecular weight compounds, intravenous and intramuscular routes of administration, and frequent, prolonged, high doses of medication.

Risk Factors

Patient Related Risk Factors

  • Gender - Women are more likely than men to have both immediate and delayed reactions, and the risk is greater in women of childbearing age.
  • Age- Drug allergy occurs more frequently in young and middle-aged adults than in infants and the elderly.
  • Genetics - Drug allergies run in families, and is associated with genetic polymorphisms in human leukocyte antigen type B (HLA-B) alleles [1].
  • Viral infections - Human immunodeficiency virus (HIV), and Epstein-Barr virus (EBV) are associated with an increased likelihood of developing immunologic reactions to drugs.
  • Prior drug allergy - A drug allergy in the past causes a person to be at a higher risk for an allergic reaction to the same drug, as well to a different type of drug.
  • Atopy - Patients with a history of atopy, such as allergic asthma or food allergy, are not at an increased risk of developing an allergic reaction to the drug, but are at higher risk for the severe clinical manifestations of drug allergy when it does occur [2].

Drug Related Risk Factors

  • High molecular weight compounds - Large macromolecular drugs such as horse antisera and insulin, or drugs that are known to haptenate by binding to tissue and proteins to elicit an immune response, are more likely to cause drug allergies.
  • Route of administration - Intravenous routes of administration are more associated with severe drug reactions, and along with topical and intramuscular routes of administration, are also more likely to cause allergic drug reactions compared with oral medications [3].
  • Dose - Prolonged high doses of medication, or frequently dosed medications, are more likely to elicit an allergic reaction than one large single dose of medication.

References

  1. Chessman D, Kostenko L, Lethborg T; et al. (2008). "Human leukocyte antigen class I-restricted activation of CD8+ T cells provides the immunogenetic basis of a systemic drug hypersensitivity". Immunity. 28 (6): 822–32. doi:10.1016/j.immuni.2008.04.020. PMID 18549801. Unknown parameter |month= ignored (help)
  2. Adkinson NF (1984). "Risk factors for drug allergy". J. Allergy Clin. Immunol. 74 (4 Pt 2): 567–72. PMID 6491103. Unknown parameter |month= ignored (help)
  3. Warrington R, Silviu-Dan F (2011). "Drug allergy". Allergy Asthma Clin Immunol. 7 Suppl 1: S10. doi:10.1186/1710-1492-7-S1-S10. PMC 3245433. PMID 22165859.



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