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Table 2 Signs indicating the possible severe progression of a DHR

From: An EAACI task force report: recognising the potential of the primary care physician in the diagnosis and management of drug hypersensitivity

Type of reaction

Signs indicating a severe reaction

Referral advised

Immediate reaction (anaphylaxis)

Sudden onset of extensive pruritus (in particular palmoplantar and scalp)

Flush on face and neck with conjunctivitis and rhinitis

Angioedema of the oral mucosa (in particular pharynx and larynx)

Severe urticaria

Dyspnea and bronchospasm (especially in asthmatics)

Hypotension

Delayed reaction

Cutaneous signs

Centrofacial edema (diffuse erythematous swelling)

Involvement of large body surfaces or erythroderma

Painful skin

Atypical target lesions

Nikolsky sign positivea

Erosive stomatitis

Mucositis (especially if affecting more than one mucosal area)

Hemorrhagic necrotizing lesions

Purpura

Signs indicating internal organ involvement

Sudden onset of high fever (> 39 °C), otherwise unexplained

Disseminated lymphadenopathy

Arthralgias and arthritis

  1. aIt is a clinical dermatological sign characterized by detachment of the epidermis when rubbing the skin with weak or moderate pressure. The sign is positive if when exerting a slight pressure there is detachment of the skin, leaving wet and red areas