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An approach to the patient with drug allergy

Werner J Pichler, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


The onset of hives within a few hours of taking a new medication is easily recognized as possible drug hypersensitivity. However, many clinical presentations of drug hypersensitivity are more complex or take place in the setting of illness and/or polypharmacotherapy. The patient in intensive care who develops a rash while receiving multiple medications, or the ambulatory patient with complex chronic diseases who develops a new and unexplained symptom while taking many medications, illustrates two common presentations of drug allergy.

The main questions that arise in such situations include the following:

Is the adverse event related to a drug?

If so, which drug is responsible?

Is the reaction due to an immune response to the drug (ie, true drug allergy) or due to another mechanism, such as pseudoallergy? (See 'Drug pseudoallergy' below.)

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Literature review current through: Nov 2017. | This topic last updated: Apr 10, 2015.
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