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 |