A Case Report :

Hypersensitivity Reaction to Drugs

Theresia Monica Rahardjo, Valentine Natasya Moenardi,

George Allan Harefa, Ghina Nisrina, Stan Jansen, Dinda Annisa Nurul Aeni
Faculty of Medicine Maranatha Christian University, Bandung
Unggul Karsa Medika Teaching Hospital, Bandung

Abstract
Background:

Hypersensitivity is a pathological immune reaction that occurs due to an excessive immune response that causes damage

to body tissues. Drug hypersensitivity reactions are included in unexpected drug adversion reactions. Drug adversion

reactions can be divided into type A (pharmacological/toxic) and type B (hypersensitivity). Manifestations of disease in

type A are predictable, depending on the dose of the drug, the toxic effect of the drug at the recommended dose or

overdosage. Type B has clinical manifestations that are not predictable and different for each individual.

keyword : Hypersensitivity, Drug Hypersentivity

Preface Case Presentation

Every individual has a different immune
system. The weaker a person's immune system
is, the more susceptible that person is to getting
sick. The effects of allergen exposure also vary
from one individual to another. Allergic
conditions are characterized by several
symptoms such as itching in certain areas of
the body, nausea, vomiting, to shortness of
breath and the worst condition is death.
Symptoms that appear depend on the part of
the body that is exposed to the allergen. Given
the symptoms that arise from hypersensitivity
reactions are very diverse and can even be life-
threatening, it is necessary to have a good
understanding of the handling of these
hypersensitivity reactions.
A twenty nine years old woman was admitted to the
emergency installation of Unggul Karsa Medika
Hospital with complaints of hyperthermia since four
days and rash since one to two days and was later
hospitalized. The history of presenting complaints
reveals that the patient was subsequently
complaints of sore throat and disphagia, and does
not reveal any other concurrent illness or co
morbidity. The patient previously seek help from
nearest clinic and was prescribed with
Dexamethasone 0,75 mg, Ibuprofen 400 mg, and
Acyclovir 400 mg. The hematological investigation
reveals anemia [Hb 11.1 mg/dL], slight increase in
segmental neutrophil count [76%], decrease in
lymphocytes count [18.0%], increase in direct and
indirect bilirubin [0.8 mg/dL;1.1 mg/dL], increase in
ALT [77 mg/dL], and blood smear test suggestive of
mild anemia normochromic normocytic ec. suspect
Fe deficiency and suspect chronic illness.

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After having second dose Dexamethasone, Discussion
Ibuprofen, and Acyclovir, the woman started
Allergies are one of the most common
developing exanthematous pustules
diseases in society. Allergy is a
reaction over the back and also disseminated
hypersensitivity reaction condition that occurs
to breast, limb and abdomen as dipicted in
when the immune system overworks against
Figure 1. By observing the woman's situation,
substances that generally do not cause
then considered to discontinue the treatment
reactions in normal people. Materials that
with previous combination to switch on to
cause allergies are called allergens, for
cetirizine and mupirocine ointment as local
example dust, mold, mites, animal dander, or
applicant to relieve from rashes and control
foods, such as nuts, eggs, shellfish, fish and
further allergy, and other medication such as
milk.
sanmol forte, omeprazole, low hemoglobin
It is estimated that 10-20% of the world's
tablet and curcuma.
population has or is currently suffering from
On examination, patient was conscious,
this disease. More than 25% of the population
oriented and stable with pulse rate of
in industrialized countries suffers from
82/min. As a part of counselling, regarding
allergies. Based on data from the Asthma and
the woman’s past history, the husband has
Allergic Foundation of America, allergies are
revealed she has not encountered with any
the sixth leading cause of chronic disease in
allergy reaction due to medication or food. It
America.
was also found that the woman has just gave
Every individual has a different immune
birth 8 months ago and currently breast-feed
system. The weaker a person's immune
her baby. By considering the above facts we
system is, the more susceptible that person is
have assessed the present data which the
to getting sick. The effects of allergen
outcome obtained from it was definite.
exposure also vary from one individual to
another. Allergic conditions are characterized
by several symptoms such as itching in certain
areas of the body, nausea, vomiting, to
shortness of breath and the worst condition is
death. Symptoms that appear depend on the
part of the body that is exposed to the
allergen. If the respiratory tract can occur
cough, itchy nose, runny nose, nasal
congestion, and wheezing. Food allergies are
associated with symptoms of nausea,
vomiting, abdominal pain and diarrhea.
Allergies to the skin can cause lesions,
Figure 1. Exanthematous pustules rashes redness, bullae, itching and so on.

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hypersensitivity syndrome, acute generalized
exanthematous pustulosis (AGEP), and
symmetrical drug-related intertriginous and
flexural exanthemas (SDRIFE). Internal
organs may be affected either singly or with
cutaneous symptoms and include hepatitis,
renal failure, pneumonitis, anemia,
neutropenia, and thrombocytopenia.
The diagnosis of a hypersensitivity reaction to
the drug is established based on a careful
history, the presence of clinical symptoms
that appear after the patient is exposed to the
allergen or precipitating factor and the
identification of the patient's physical
findings. A careful history can provide an
explanation of the cause of the
hypersensitivity reaction to the drug. Based on
the history and physical examination results,
diagnostic tests such as skin tests, graded
challenges, and induction of drug tolerance
procedures are also required.
Drug hypersensitivity reactions are included in
unexpected drug adversion reactions.
Drug adversion reactions can be divided into
type A (pharmacological/toxic) and type B
(hypersensitivity).
The disease manifestations in type A are
predictable, depending on the dose of the
drug, the toxic effect of the drug at the
recommended dose or the overdose. Type B
has unpredictable clinical manifestations and
varies from individual to individual. Symptoms
occur within one to six hours of taking the
drug or hours to days with symptoms ranging
from mild (sneezing) to severe (anaphylaxis).
Given the symptoms that arise from
hypersensitivity reactions are very diverse and
can even be life threatening, it is necessary to
have a good understanding of the handling of
these hypersensitivity reactions.
Hypersensitivity is a pathological immune
reaction that occurs due to an excessive
immune response that causes damage to
body tissues. Hypersensitivity reactions
according to Coombs and Gell are divided into
four types of reactions based on the speed
and mechanism of the immune system that
occurs, namely types I, II, III, and IV.
The World Health Organization defines
adverse drug reactions (ADRs) as unwanted
and adverse reactions resulting from the
response to the use of drugs at doses as
recommended in humans for therapeutic,
prophylactic, diagnostic, or physiological
function modifications.
Pharmacological classification is divided into
two. subtypes: type A and type B reactions.
Type A reactions are predictable and dose-
dependent pharmacological effects. Most
ADRs (about 80%) are type A reactions,
including toxic effects, side effects,
secondary effects and drug interactions.
Reaction B is an unpredictable and dose-
independent hypersensitivity reaction. This
hypersensitivity reaction causes symptoms or
signs at doses that can be tolerated by a
normal person. Approximately 10%-15% of
all ADRs are type B reactions.
Drug allergy is a hypersensitivity reaction
involving an immune mechanism (IgE or T
cell-mediated or rarely involving immune
complexes or cytotoxic reactions). All cases
of drug hypersensitivity reactions without
going through an immune mechanism
(5%-10%) or unproven immunological
processes are classified as non-immune
hypersensitivity reactions.
In patients with drug hypersensitivity
reactions, many clinical manifestations can be
seen. Clinically visible, can help to make a
diagnosis and treat patients quickly. Acute
manifestations of drug hypersensitivity
reactions usually include urticaria,
angioedema, rhinitis, conjunctivitis,
bronchospasm, gastrointestinal symptoms
(nausea, vomiting, diarrhea) or anaphylaxis,
which can lead to cardiovascular collapse.
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Delayed reaction to drug hypersensitivity often
affects the skin with various cutaneous
symptoms, such as delayed urticaria,
maculopapular eruptions, fixed drug eruptions
(FDE), vasculitis, blistering disease (Toxic
Epidermal Necrosis (TEN), Steven Johnson
Syndrome (SJS) and bulla FDE. general),

Conclusion
Allergies are one of the most common diseases
in society. Allergy is a hypersensitivity reaction
condition that occurs when the immune system
overworks against substances that generally do
not cause reactions in normal people.
Drug hypersensitivity reactions are
unpredictable side effects of drugs. Factors
associated with an increased risk of drug allergy
include age, sex, genetic polymorphisms, viral
infection and drug-related factors (frequency of
exposure, route of administration, molecular
weight).
An effective strategy for drug allergy
management is to avoid or discontinue use of
the suspected drug.
If at that time the patient was taking various
drugs, if possible all of them were discontinued.
But if not, only essential drugs can be given and
the least likely is known cause an allergic
reaction.

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