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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