Tag: SCARs

Drug vs Food Allergy: Immediate & Delayed Reactions

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Infographic comparing drug vs food allergy: immediate (anaphylaxis) and delayed reactions; SJS/TEN uncommon with food.

Drug vs Food Allergy: Why Medications Can Cause Both Immediate and Delayed Reactions — While Foods Uncommonly Cause Severe Delayed Reactions This article is for educational purposes only. Always consult healthcare providers for personalized medical advice. Patients often ask:“Why can medications cause both rapid allergic reactions like hives or anaphylaxis and dangerous delayed reactions such as Stevens–Johnson Syndrome (SJS) or Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), while food allergies almost always appear immediately?” The difference lies in how the immune system processes drugs versus foods — and in…

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ROAT Patch Testing in SCARs: Is It Time to Reconsider?

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Illustration symbolizing drug allergy testing with ROAT in severe cutaneous adverse reactions (SCARs) such as DRESS, AGEP, and FDE

Introduction Severe cutaneous adverse reactions (SCARs) — such as DRESS, AGEP, and SJS/TEN — are among the most serious drug hypersensitivity syndromes.The traditional approach is simple: avoid all suspected drugs indefinitely. But this blanket avoidance often creates real-world problems: This raises an important question:👉 Is it time to reconsider the role of patch testing — and even the Repeated Open Application Test (ROAT) — in managing SCARs? Why ROAT Is Feared in SCARs The Repeated Open Application Test (ROAT) is a simple diagnostic tool in delayed hypersensitivity: Concerns in SCARs:…

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When and How to Perform Drug Provocation Tests in Drug Hypersensitivity: Timing Matters

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Introduction Drug provocation test timing plays a critical role in evaluating suspected drug allergies. Drug provocation testing (DPT), also known as a drug challenge, remains the gold standard for confirming or ruling out drug hypersensitivity. However, success depends heavily on understanding how soon after drug exposure symptoms appear. By tailoring the timing and protocol of DPT based on the type of reaction—immediate, delayed, or severe—clinicians can improve diagnostic accuracy and minimize risk. This post outlines practical strategies, guideline updates, and real-world challenges that affect how and when drug provocation tests…

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Rethinking Drug Allergy Management: Finding Balance Between Caution and Access in SCARs

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Drug allergies present a complex landscape, demanding tailored management strategies based on the reaction’s nature and severity. We’ve witnessed significant progress in “de-labeling” allergies to common drugs like penicillin through careful testing, allowing many to safely access essential treatments. However, the approach to severe cutaneous adverse reactions (SCARs) – encompassing Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), and Acute Generalized Exanthematous Pustulosis (AGEP) – often stands in stark contrast: a broad and often indefinite avoidance of all potentially implicated drugs. While the…

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Chemotherapy Hypersensitivity Reactions: Immediate vs. Non-Immediate Responses and How to Manage Them

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Introduction Hypersensitivity reactions to chemotherapy—ranging from mild rashes to life-threatening anaphylaxis—can complicate treatment and require expert diagnosis and management. Immediate Reactions: Diagnosis and ManagementImmediate hypersensitivity reactions to chemotherapies are relatively common and easier to confirm compared to non-immediate reactions. Symptoms such as urticaria, wheezing, or anaphylaxis often appear during or shortly after drug administration. In some cases, nausea, vomiting, or back pain may also occur as part of anaphylaxis symptoms, though these are less typical and can overlap with side effects of chemotherapy itself. Key Diagnostic Tools:• Skin Testing with…

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Reevaluating the Approach to Severe Cutaneous Adverse Reactions (SCARs): Is Drug Rechallenge Always Off the Table?

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Severe Cutaneous Adverse Reactions (SCARs), such as acute generalized exanthematous pustulosis (AGEP), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), and Stevens-Johnson Syndrome (SJS), are among the most feared drug-related complications. These conditions can result in devastating outcomes, and the conventional approach to managing SCARs emphasizes strict avoidance of the suspected culprit drug to prevent potentially fatal recurrences. But is avoidance always the only path forward? Could there be room for a more nuanced strategy in specific cases? Not All SCARs Are Created Equal SCARs represent a spectrum of disorders,…

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