Drug Allergy Flashcards
What % of the population report an allergy to penicillin?
1 - 1%
2 - 5%
3 - 10%
4 - 20%
3 - 10%
What % of the hospital inpatients report allergy to penicillin?
1 - 1%
2 - 5%
3 - 10%
4 - 30%
4 - 30%
Although allergy to penicillin may be reported between 10-30%, what is the true prevalence?
1 - 0.1%
2 - 1-2%
3 - 5-10%
4 - >20%
2 - 1-2%
- patients may have had a reaction initially, but sensitisation is lost at around 10%/year
What type of response is a type 1 hypersensitivity?
1 - IgE antibodies produced
2 - antibody-dependent cytotoxic
3 - antibody complex mediated
4 - cell mediated or delayed
1 - IgE antibodies produced
- cause mass cell sensitisation
What type of response is a type 2 hypersensitivity?
1 - IgE antibodies produced
2 - antibody-dependent cytotoxic
3 - antibody complex mediated
4 - cell mediated or delayed
2 - antibody-dependent cytotoxic
- complement system is activated causing immune response
What type of response is a type 3 hypersensitivity?
1 - IgE antibodies produced
2 - antibody-dependent cytotoxic
3 - antibody complex mediated
4 - cell mediated or delayed
3 - antibody complex mediated
- anti-bodies react with soluble antigens and then clump together in tissue
What type of response is a type 4 hypersensitivity?
1 - IgE antibodies produced
2 - antibody-dependent cytotoxic
3 - antibody complex mediated
4 - cell mediated or delayed
4 - cell mediated or delayed
- no antibodies
Type I hypersensitivity is caused by sensitisation of mast cells and the secretion of IgE antibodies. How long does it normally take for this reaction to occur if a patient is allergic to a drug?
1 - 1 minute
2 - 10 minutes
3 - 1 hour
4 - 10 hours
3 - 1 hour
- severity is scored according to Ring and Messemer 4 step grading scale based on clinical manifestations
Which of the 4 main hypersensitivities does anaphylactic shock come under?
1 - type I
2 - type II
3 - type III
4 - type VI
1 - type I
Atopic patients are just as likely to suffer a type I anaphylactic shock than non atopic patients. However, there is one incidence when atopic patients are at a greater risk. What is this called?
1 - type I sensitisartion
2 - NSAID-Exacerbated Respiratory Disease (N-ERD)
3 - respiratory distress syndrome
4 - NSAIDs disease
2 - NSAID-Exacerbated Respiratory Disease (N-ERD)
- patient is sensitive to NSAIDs
Are atopic patients more likely to suffer a type I anaphylactic shock than non atopic patients?
- no same risk
In a non-allergic type I hypersensitivity will patients experience anaphylactic shock immediately?
- no
- first exposure sensitises mast cells with IgE
- second exposure means mast cells are primed and anaphylactic shock follows
During degranulation of mast cells in a type I hypersensitivity, what are the 2 chemicals that are released by mast cells causing anaphylactic shock?
1 - histamine and CRP
2 - histamine and tryptase
3 - tryptase and CRP
4 - CRP and CK
2 - histamine and tryptase
During degranulation of mast cells in a type I hypersensitivity, histamine and tryptase are released following degranulation of mast cells. What do these 2 molecules then go onto to form which causes anaphylactic shock?
1 - leukotriene, CRP, thromboxane
2 - leukotriene, prostoglandin, thromboxane
3 - prostoglandin, CRP, thromboxane
4 - leukotriene, prostoglandin, CRP
2 - leukotriene, prostoglandin, thromboxane
During degranulation of mast cells in a type I hypersensitivity, some drugs are able to bind with mast cells and sensitise them causing the issue. What are some key drugs that this has been shown in?
- vancomyocin
- NSAIDs
- ACE inhibitors
- opiates
What is the Ring and Messemer 4 step grading scale?
- clinical scale used for type I ana
What is the Ring and Messemer 4 step grading scale?
- clinical scale used for type I anaphylaxis
Using the clinical scaled for type 1 anaphylaxis called the Ring and Messemer 4 step grading scale, what is grade I?
1 - cardiac arrest
2 - moderate multi-visceral signs (swelling), hypotension, tachycardia, GIT upset and some brochospasms
3 - life threatening swelling, tachycardia, hypotension, GIT issues and brochospasms
4 - erythema, itchy, may or may not have angioedema
4 - erythema, itchy, may or may not have angioedema
Using the clinical scaled for type 1 anaphylaxis called the Ring and Messemer 4 step grading scale, what is grade 2?
1 - cardiac arrest
2 - moderate multi-visceral signs (swelling), hypotension, tachycardia, GIT upset and some brochospasms
3 - life threatening swelling, tachycardia, hypotension, GIT issues and brochospasms
4 - erythema, itchy, may or may not have angioedema
2 - moderate multi-visceral signs (swelling), hypotension, tachycardia, GIT upset and some brochospasms
Using the clinical scaled for type 1 anaphylaxis called the Ring and Messemer 4 step grading scale, what is grade 3?
1 - cardiac arrest
2 - moderate multi-visceral signs (swelling), hypotension, tachycardia, GIT upset and some brochospasms
3 - life threatening swelling, tachycardia, hypotension, GIT issues and brochospasms
4 - erythema, itchy, may or may not have angioedema
3 - life threatening swelling, tachycardia, hypotension, GIT issues and brochospasms
Using the clinical scaled for type 1 anaphylaxis called the Ring and Messemer 4 step grading scale, what is grade 4?
1 - cardiac arrest
2 - moderate multi-visceral signs (swelling), hypotension, tachycardia, GIT upset and some brochospasms
3 - life threatening swelling, tachycardia, hypotension, GIT issues and brochospasms
4 - erythema, itchy, may or may not have angioedema
1 - cardiac arrest
Type II, III or IV drug hypersensitivity responses are not immediate. How long from being given the first exposure to a drug do symptoms present?
1 - 1-5 days
2 - 3-5 days
3 - 5-8 days
4 - >5 days
3 - 5-8 days
- this would be the first sensitisation
- type IV is most common
Type II, III or IV drug hypersensitivity responses are not immediate. How long do symptoms present if they patient has previous been exposed to this drug before?
1 - 1-5 days
2 - 3-5 days
3 - 5-8 days
4 - >5 days
2 - 3-5 days
- type IV is most common
What is the most common group of drugs that cause Type II, III or IV drug hypersensitivity responses?
1 - antibiotics
2 - NSAIDs
3 - antimicrobials
4 - ACE inhibitors
3 - antimicrobials
What type of hypersensitivity is most likely to be present in the image below:
1 - type I
2 - type II
3 - type III
4 - type IV
4 - Type IV
- patient is normally not severely ill
What are erythema multiforme minor?
- symmetrical, red, raised skin lesions
- present all over the body BUT NOT mucus membranes
Erythema multiforme minor are symmetrical, red, raised skin lesions that can occur anywhere on the body except mucus membranes. What other symptoms do patients present with?
1 - itching, cold sores, fatigue, joint pains, fever
2 - stiff neck, cold sores, fatigue, joint pains, fever
3 - weight loss, cold sores, fatigue, joint pains, fever
4 - itching, cold sores, fatigue, joint pains, stiff neck
1 - itching, cold sores, fatigue, joint pains, fever
Erythema multiforme minor are symmetrical, red, raised skin lesions that can occur anywhere on the body except mucus membranes. What common medications can trigger this?
1 - B-blockers, tetracyclines, amoxicillin and ampicillin, NSAIDs and anticonvulsants
2 - Sulfonamides, tetracyclines, amoxicillin and ampicillin, NSAIDs and beta blockers
3 - Sulfonamides, tetracyclines, amoxicillin and ampicillin, NSAIDs and anticonvulsants
4 - Sulfonamides, tetracyclines, amoxicillin and ampicillin, ACE inhibitors and anticonvulsants
2 - Sulfonamides, tetracyclines, amoxicillin and ampicillin, NSAIDs and anticonvulsants
Erythema multiforme minor are symmetrical, red, raised skin lesions that can occur anywhere on the body except mucus membranes. Can these only be caused by drug hypersensitivity reactions?
- no
- can be caused by infection such as HSV, mycoplasma and fungal
Erythema multiforme minor are symmetrical, red, raised skin lesions that can occur anywhere on the body except mucus membranes. However, if this begins to affect the mucus membranes, what is this then referred to as?
- Erythema multiforme major
or Stevens-Johnson Syndrome
What are the 3 high risk medications that has been linked with drug hypersensitivity reactions?
1 - aspirin, antibiotics, NSAIDS
2 - NSAIDS, antibiotics, B-blockers
3 - NSAIDS, antibiotics, taxane chemotherapy
4 - aspirin, antibiotics, taxane chemotherapy
3 - NSAIDS, antibiotics, taxane chemotherapy
If a patient is having a grade III or IV hypersensitivity reaction, why can cutaneous (skin) not always be the best indicator of the patients condition?
1 - skin colour may make it harder
2 - older skin is not as affected
3 - low cardiac output
4 - respiratory distress
3 - low cardiac output
- less blood reaches skin, so does not appear to be as affected
If a patient is having an immediate drug hypersensitivity reaction, what is the first course of action?
1 - finish the drug course then stop it
2 - stop the drug immediately
3 - slowly finish the drug
4 - prescribe an alternative drug
2 - stop the drug immediately
If a patient is having an immediate drug hypersensitivity reaction, why would we raise their legs?
- increase venous return and cardiac output
If a patient is having an immediate drug hypersensitivity reaction, we have called for help, stopped their drug and raised their legs ti improve cardiac output, what do we do next?
1 - 100% O2 and infusion of IV fluids
2 - 100% Os only
3 - IV fluids only
4 - give adrenaline
1 - 100% O2 and infusion of IV fluids
- crystallised IV fluids at 20-30 ml/kg
If a patient is having an immediate drug hypersensitivity reaction, we have called for help, stopped their drug and raised their legs ti improve cardiac output, given them 100% o2 and infused crystallised fluids via IV, what is the next and potentially most important thing to do if the patient still has cardiac output?
1 - give adrenaline
2 - move to ICU
3 - intubate
4 - ECG
1 - give adrenaline intramuscularly
- repeat every 5 minutes
It is crucial to give adrenaline to a patient if they are having an immediate drug hypersensitivity reaction and still have cardiac output. What dose should it be prescribed?
1 - 1:10
2 - 1:100
3 - 1:1000
4 - 1:10000
3 - 1:1000
given as half a ml (same as half a mg)
If a patient is a non-immediate drug hypersensitivity reaction (or Severe Cutaneous Adverse Reactions (SCARS)) what are the most likely clinical presentations?
1 - fever, cough, conjunctivitis, mucositis
2 - headache, cough, conjunctivitis, mucositis
3 - fever, cough, conjunctivitis, stiff neck
4 - fever, headache, conjunctivitis, mucositis
1 - fever, cough, conjunctivitis, mucositis
If a patient is a non-immediate drug hypersensitivity reaction (or Severe Cutaneous Adverse Reactions (SCARS)) how long will it be before they present after the drug has been administered?
1 - 1-3 days
2 - 2-5 days
3 - 3-8 days
4 - >10 days
3 - 3-8 days
Is a non-immediate drug hypersensitivity reaction (or Severe Cutaneous Adverse Reactions (SCARS)) more common in men or women?
- more common in men
- younger people <30 y/o
If a patient is a non-immediate drug hypersensitivity reaction (or Severe Cutaneous Adverse Reactions (SCARS)) does this have a high mortality?
- yes
- severity of reaction becomes worse following repeated exposure
Some of the most common drugs that can cause a non-immediate drug hypersensitivity reaction (or Severe Cutaneous Adverse Reactions (SCARS)) are Allopurinol, Carbamazepine, Lamotrigine, Nevirapine, NSAIDs, Oxicam, Phenobarbital, Phenytoin Sulfamethoxazole and other sulfa antibiotics, Sulfasalazine. But is it only drugs that can cause the symptoms the patient is presenting with?
- no
- can be caused by the infection
If a patient presents with severe cutuansou symptoms such as in Severe Cutaneous Adverse Reactions (SCARS)), who would you refer the patient to?
1 - radiology
2 - ITU/burns team
3 - ICU
4 - A&E
2 - ITU/burns team
What is the SCORTEN scale is a severity-of-illness scale?
- scale to asses the predicted mortality following a non-immediate drug hypersensitivity reaction (or Severe Cutaneous Adverse Reactions (SCARS))
- age >40 years
- presence of malignancy
- HR >120 beats/min
- epidermal detachment >10% BSA at admission
- serum urea >10 mmol/L
Serum glucose >14 mmol/L
Bicarbonate <20 mmol/L
Score 1 for each criterion
1 = 4% mortality, 7 = 99% mortality
Once a patient has recovered from the initial anaphylaxis which 2 of the following must you do?
1 - measure mass cell tryptase between 6-24 hours
2 - refer to ICU and do FBC
3 - lumbar puncture
4 - measure plasma histamine within 30 minutes and up to 2 hours
1 - measure mass cell tryptase between 6-24 hours
4 - measure plasma histamine within 30 minutes and up to 2 hours
Once a patient has recovered from the initial anaphylaxis and you have collected mast cell tryptase and histamine, what must you then do as the doctor looking after the patient?
1 - find them a bed for the night to monitor them
2 - refer to allergy clinic with detailed allergies
3 - refer to ICU for monitoring
4 - leave for sister on ward to supervise
2 - refer to allergy clinic with detailed allergies
- detailed description of what to avoid in future is important
If a patient presents and has previous had a drug hypersensitivity reaction, what is the most important thing to do as the doctor in charge of their care?
1 - detailed medical history
2 - refer to ICU
3 - refer to more senior clinician
4 - seek previous doctor who treated the patient
1 - detailed medical history
- when, where, timing, duration, further exposure
If a patient presents and has previous had a drug hypersensitivity reaction, and they are not in a life threatening condition, where should they be referred to if there is no alternative drugs and time permits?
1 - find them a bed for the night to monitor them
2 - refer to allergy clinic with detailed allergies
3 - refer to ICU for monitoring
4 - leave for sister on ward to supervise
2 - refer to allergy clinic with detailed allergies
What is the B lactam allergy test?
- patient is tested for the presence of B lactams
The B lactam allergy test is the only commercially available test for B lactams. What happens if a patient has a positive test?
- patients skin is challenged using alternative antibiotis
The B lactam allergy test is the only commercially available test for B lactams. What happens if a patient has a negative test?
- patient is test again for B lactam antibiotics
A challenge test can be performed in a hospital to assess for allergies to a drug. How does this test work?
- drug given orally
- gradual increase in drug dose every 30 minutes
A challenge test can be performed in a hospital to assess for allergies to a drug. This involves giving the drug orally with a gradual increase in drug dose every 30 minutes. Is this able to detect all types of hypersensitivity?
- no only type I hypersensitivity
If a patient is referred to the allergy clinic, which of the following is NOT something they can help with:
1 - Understanding and empowerment
2 - Patient held record and MedicAlert bracelet
3 - ensure all documents include allergies
4 - diagnose all types of drug hypersensitivities
4 - diagnose all types of drug hypersensitivities
If the allergy clinic has confirmed that a patient has a type 1 hypersensitivity to a specific drug, is it just that drug that they will be told to avoid?
- no
- the whole drug class should be avoided
If the allergy clinic has confirmed that a patient has a type IV hypersensitivity to a specific drug, is it just that drug that they will be told to avoid?
- if the specific drug can be identified YES
- other drug in the same class are OK
Do allergy clinics generally give adrenalin auto injectors to patients once they have confirmed the drug they have had the drug hypersensitivity to?
- no
- once the patient knows the drug they should avoid it and it will be in their clinical notes
