Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

500 Drug Allergy Drug and Toxin-Induced Liver Diseases

specific therapy

■Anaphylaxis: epinephrine, subcutaneous or if necessary IV H1 & H2

blockers; corticosteroids of marginal benefit

■Serum sickness: H1 & H2 blockers, NSAIDs, oral corticosteroids in

severe cases

■Cutaneous reactions: H1 & H2 blockers; systemic corticosteroids

often required in mucocutaneous disease, erythema nodosum, vas-

culitis

■Hospitalization & intensive care for toxic epidermal necrolysis

■Hematologic reactions often require systemic corticosteroids, some-

times immunosuppressive agents (eg, cyclophosphamide)

■Lupus-like syndrome: NSAIDs, hydroxychloroquine, occasionally

brief course of low-dose oral corticosteroids

■Renal & pulmonary involvement usually abates w/ discontinuation

of responsible agent, may require corticosteroids

follow-up

■Daily, during treatment of anaphylaxis, severe cutaneous disease, to

assess response to therapy

■Weekly or monthly in lupus-like syndrome, other prolonged disease

complications & prognosis

■The majority of allergic reactions to drugs are reversible & w/out seri-

ous sequelae, provided they are promptly diagnosed & the offending

agent discontinued.

■Maintenance of the allergic state to a particular drug is unpre-

dictable. The majority fades w/ time (years).

■Re-challenging w/ the offending drug to document the allergic state

is unwise.

■If re-administration of the drug is absolutely required for effective

therapy (eg, penicillin in enterococcal endocarditis, allopurinol in

tophaceous gout w/ renal failure), consultation w/ an allergist for

skin testing & desensitization to the agent is recommended.

Drug and Toxin-induced Liver Diseases....................

MINDIE H. NGUYEN, MD

history & physical

History

■acetaminophen: intake >15 g in 80% of serious cases; toxic dose

5–10 g in alcoholics; acute GI symptoms in first 24 hr, followed by