Medical history (history of illness) represents an important component in the diagnosis of drug exanthema. Family history
Social history
Current anamnesis/systemic anamnesis (somatic and psychological complaints).
- What changes have you noticed in yourself?
- How long have these changes existed?
- Have you taken any medications recently? If yes, which ones?
- Are there any other possible triggering factors such as foods, supplements?
Vegetative anamnesis including nutritional anamnesis.
- Do you use drugs? If yes, which drugs (opiates) and how often per day or per week?
Self history incl. medication history.
- Pre-existing conditions (autoimmune diseases, viral infections).
- Surgeries
- Allergies
Medication history
- ACE inhibitor4
- Allopurinol
- Analgesics
- Non-acidic analgesics (metamizole, paracetamol).
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – ibuprofen, diclofenac, naproxen, salicylates (acetylsalicylic acid, ASA).
- Opioid receptor antagonist (naltrexone).
- Phenazone derivatives6
- Pyrazolones6
- Antibiotics
- Aminoglycosides1
- Betalactam antibiotics1 (β-lactam antibiotics) (approximately 50% of all drug intolerances; approximately 07-8% of all patients allergic to β-lactam antibiotics)
- Aminopenicillins (amoxicillin).
- Cephalosporins
- Quinolones (ciprofloxacin, moxifloxacin).
- Chloramphenicol3
- Epoxide antibiotics (fosfomycin trometamol).
- Polypeptide antibiotic (bacitracin3)
- Macrolide antibiotics/macrolides (erythromycin)
- Neomycin3
- Nitrofurans (nitrofurantoin)
- Penicillins3
- Sulfonamides1, 3, 6 (sulfamethoxazole)
- Sulfones (dapsone)
- Staphylococcal penicillins (flucloxacillin)
- Tetracyclines4, 6
- Trimethoprim
- Antiepileptic drugs (carbamazepine)
- Antihistamines3
- Antihypertensives
- ACE inhibitors (enalapril)
- Beta-blocker4
- Methyldopa
- Antifungals
- Allylamines (terbinafine)
- Griseofulvin
- Antiprotozoal
- Analogue of the azo dye trypan blue (suramin).
- Pentamidine
- Anthelmintics (diethylcarbamazine, mebendazole, niclosamide).
- Antitussives
- Opioids (codeine, dihydrocodeine, hydrocodone).
- Non-opioid antitussives (levodropropizine, noscapine, pentoxyverine).
- Antihistamines (cimetidine).
- Antipsychotics (neuroleptics) – chlorpromazine, phenothiazine.
- Arsenic trioxide
- Chelating agent
- D-penicillamine
- Trieethylenetetramine dihydrochloride (Trien)
- Quinidine4
- Chloroquine4
- Cinnarizine5
- Diuretics (furosemide, hydrochlorothiazole, thiazides4)
- Folic acid antagonist (methotrexate).
- Fusion inhibitors (enfuvirtide).
- Gold4 (gold salts)
- Heparin2
- Hormones
- Insulins2
- Thyroid medications, unspecified
- Hydantoins1
- Insecticides and acaricides (contact insecticides).
- Pyrethroids (allethrin, permethrin).
- Pyrethrins (pyrethrum)
- Lithium4
- Local anesthetics (benzocaine3, lidocaine3)
- Perchlorates (perchlorate)
- Parasympatholytics (also called anticholinergics) – atropine.
- Penicillamine5
- Phytotherapeutics (St. John’s wort)
- X-ray contrast agent 1 + maculopapular drug exanthema.
- Sedatives
- Barbiturates1
- Benzodiazepines
- Tuberculostatics (isoniazid
- Tyrosine kinase inhibitors (TKi) – imatinab
- Vasodilators (hydralazine1)
- Antivirals
- Nucleoside analogues (aciclovir, cidofovir, famciclovir, foscarnet, ganciclovir, valaciclovir).
- Cytokines2 (interferon ß-1a, interferon ß-1b, glatiramer acetate).
- Cytostatics
- Alkylants (Adriamycin, Doxorubicin).
- Platinum derivatives (carboplatin)
- Taxanes (paclitaxel)
1 Type I allergy (immediate type) 2 Type III allergy (Arthus phenomenon) 3 Type IV allergy (allergic late-type reaction)/allergic contact dermatitis 4 Type IV allergy (allergic late-type reaction)/Lichen ruber-like or psoriasiform DMD 5 Type IV allergy (allergic late-type reaction)/blistering DMD.
6 Fixed drug exanthema
The list of drugs represents only the most common triggers. There is no claim to completeness.
Penicillin allergy – a rapid test (PEN-Fast)
PEN-Fast is an acronym used as a memory aid:
| Abbreviation | Definition | Points |
| PEN | Patient reports allergy to penicillin | 0 |
| F | Allergic reaction to penicillin not more than five years ago | 2 |
| A | Anaphylaxis or angioedema | 2 |
| S | Severe major allergic reaction (e.g., Stevens Johnson syndrome (SJS), toxic epidermal necrolysis, eosinophilia + systemic symptoms) | |
| T | Therapy of allergic reaction required | 1 |
Interpretation
- PEN-FAST < 3: low allergy risk (negative predictive value (NPV) of such a result was approximately 96%).
