Delayed Hypersensitivity Reactions
Description General and supportive measures Medicine treatment Referral See Erythema multiforme See Stevens-Johnson syndrome (SJS)/Toxic epidermal necrosis (TEN) See Drug reactions DESCRIPTION Broad spectrum of clinical manifestations involving different organs, including liver, kidneys and skin. Cutaneous reactions are most prevalent and range from maculopapular or morbilliform
General and supportive measures
See Stevens-Johnson syndrome (SJS)/Toxic epidermal necrosis (TEN)
See Drug reactions
DESCRIPTION
Broad spectrum of clinical manifestations involving different organs, including liver, kidneys and skin. Cutaneous reactions are most prevalent and range from maculopapular or morbilliform rashes (most common presentation), to life-threatening cutaneous reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Common drugs associated are antiretrovirals (efavirenz or nevirapine), anticonvulsants, anti-tuberculous therapy, penicillins and co-trimoxazole.
GENERAL AND SUPPORTIVE MEASURES
Stop the suspected causative medicine(s) immediately. Use an alternative class of agent if required.
If there are compelling reasons to continue with the suspected medicine, seek expert advice.
Severe cutaneous reactions will usually require admission and intensive supportive therapies. See Erythema Multiforme and Stevens-Johnson syndrome (SJS)/Toxic epidermal necrosis (TEN).
MEDICINE TREATMENT
Mild reactions without systemic or mucosal involvement may be treated symptomatically:
- Chlorphenamine, oral, 0.1 mg/kg/dose 6 hourly.
If child is asthmatic, see Respiratory System: Conditions with predominant wheeze
REFERRAL
- SJS/TEN for management in a specialist centre with experience or a unit familiar with managing burns.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 25: Drug Allergies, 24.3 Delayed Hypersensitivity Reactions