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Drug allergy.

Allergy Asthma Clin Immunol

January 2025

Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada.

Drug allergy encompasses a spectrum of immunologically-mediated hypersensitivity reactions (HSRs) with varying mechanisms and clinical presentations. This type of adverse drug reaction (ADR) not only affects patient quality of life, but may also lead to delayed treatment, unnecessary investigations, and increased morbidity and mortality. Given the spectrum of symptoms associated with the condition, diagnosis can be challenging.

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A 70-years-old man with metastatic hormone-sensitive prostate cancer received the apalutamide, an oral androgen receptor signaling inhibitor. On day10 after drug initiation, fever and skin rash appeared on his whole-body surface. He stopped taking the drug on day18 and skin symptoms temporarily improved about 7 days after discontinuation.

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Acute generalized exanthematous pustulosis is a severe cutaneous adverse reaction characterized by the rapid onset of nonfollicular, sterile pustules on an erythematous base, typically accompanied by fever (≥38 °C), neutrophilia (7.0 × 10⁹/L), and characteristic histopathological features. This case report presents the first documented instance of acute generalized exanthematous pustulosis after hyaluronic acid viscosupplementation.

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Drug-induced enterocolitis syndrome (DIES), little known due to its recent description, is analogous to food protein-induced enterocolitis syndrome (FPIES). Both processes are more frequent in pediatric age and share diagnostic criteria, the main one being the appearance of persistent vomiting 1-4 hours after ingestion of the drug or food, in the absence of IgE-mediated allergy symptoms.

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Article Synopsis
  • The study examines the adverse events (AEs) linked to clarithromycin, an antibiotic, across different age groups using data from the FDA Adverse Event Reporting System (FAERS).
  • Common AEs include vomiting and diarrhea in younger age groups, while older adults experience issues like abnormal taste and drug interactions.
  • Eighteen age-specific signals were identified, highlighting the need for tailored monitoring and management of clarithromycin's safety profile in different age demographics.
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