Page 64 - Proceeding of Plenary Abstract of Parallel Symposim

ALERGI IMUNOLOGI

Insights into the Management of Drug Allergy

Dina Muktiarti
Department of Child Health Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Drug allergy is an immunologically mediated drug hypersensitivity reactions and account for
approximately 6% to 10% of all adverse drug reaction. The immediate management of drug allergy is to stop
the culprit drug. The next step is to provide treatment according to the patient’s symptoms (i.e. anaphylaxis,
mild-moderate or severe cutaneous reaction). Discussion Physician should elaborate the risk stratification
to make appropriate long-term management. Confirming the diagnosis of drug allergy, select the alternative
drugs, and desensitization should be discussed in detail with patients and/or their parents. A thorough history
taking and physical examination is important to determine severity of the drug allergy. Drug provocation test is
the gold standard for evaluating drug allergy. It can be used for confirming the drug allergy, proving tolerance,
or finding safe alternative drugs. Avoidance of the culprit drug and cross-reacting drug is necessary. Physician
should make an effort to identify the alternative drug of choice. Drug desensitization should be considered
if there is no alternative drug option available or if the drug is the first-line treatment and desensitization is
not contraindicated. Drug desensitization is a procedure that modifies a patient’s immune response to a drug,
so that the patient has a temporary tolerance to the specific drug until the drug is eliminated (2-3 half-lives).
This procedure is most successful if the history is strongly suggestive of an IgE-mediated reaction. It is also
important to ensure that drug allergy status is documented in the medical record. A thorough discussion with
the parents is needed to avoid unnecessary anxiety and to make sure that they aware of all drugs to avoid and
what the alternative drugs can be given to the patient.
Keywords: drug allergy; drug provocation test; desensitization

How to Evaluate Cutaneous Manifestations of Drug Hypersensitivity

Nurul Iman Nilam Sari
Pediatric Department, Harapan Kita Women and Children Hospital, Jakarta, Indonesia

Abstract
Background Drug hypersensitivity reactions (DHRs) are common, and the skin is by far the most frequently
involved organ with a broad spectrum of reaction types. The diagnosis of cutaneous DHRs (CDHR) may
be difficult because of multiple differential diagnoses. A correct classification is important for the correct
diagnosis and management. European Academy of Allergy and Clinical Immunology (EAACI) guideline
aim to give precise definitions and provide the background needed for doctors to correctly classify CDHR.
Methods This guideline is based on evidence as well as on expert opinion included a literature search in
MEDLINE. Results Correct classification of CDHR into well‐defined entities strongly depends on a
thorough clinical examination and correct description of morphological features of the skin. As skin lesions
constitute the essential foundation for later diagnosis. Drug hypersensitivity reactions have also been classified
according to chronology. Immediate (acute) DHRs are correspondent to urticaria, angioedema and/or
anaphylaxis occurring nearly always within the first hour, and nonimmediate (late) exanthems occur later
than 6 hours, mostly 24 hours, after drug intake. Whilst morphological classification from characterization of
primary lesions and clinical features remains most important, sometimes chronology gives further clues to the
diagnosis, or aids exclusion of CDHR, or differentiation between CDHR. The history and the clinical picture
have important implications for management in the acute stage of the disease and for planning of diagnostic
tests to be done later. If possible, patients should be assessed by experts during the acute phase of a reaction,
enabling exclusion of several differential diagnoses both from the clinical picture and by histopathology,
classification of clinical manifestations, recording of drugs used and follow-up of the course of the reaction.
Conclusion To make the correct diagnosis based on morphology, it is crucial to identify primary and secondary
lesions and to use allergological and dermatological terms appropriately.
Keywords: practical approach, cutaneous manifestation, drug hypersensitivity

Kongres Nasional Ilmu Kesehatan Anak XVIII 49