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Current Clinical Pharmacology

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ISSN (Print): 1574-8847
ISSN (Online): 2212-3938

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Review Article

Multiple Drug Intolerance Syndrome: An Underreported Distinct Clinical Entity

Author(s): Sapan K. Behera, Saibal Das, Kavadichanda G. Chengappa, Alphienes S. Xavier and Sandhiya Selvarajan *

Volume 14, Issue 2, 2019

Page: [84 - 90] Pages: 7

DOI: 10.2174/1574884713666181112125714

Abstract

Aim: Multiple drug intolerance syndrome (MDIS) is a unique clinical entity distinct from other drug hypersensitivity syndromes. The aim of this review was to critically appraise the various aspects of MDIS.

Methods: A review was conducted to search for the causes, mechanism, clinical features, and management of MDIS.

Results: The most common cause of MDIS is antibiotics followed by non-steroidal antiinflammatory drugs (NSAIDs). Although some non-specific immunological mechanisms are involved, the immunological tests for MDIS are negative. Rashes, gastrointestinal reflux, headache, cough, muscle ache, fever, dermatitis, hypertension, and psychiatric symptoms are the usual manifestations. Treatment is mostly symptomatic with the withdrawal of the offending drug. Drug rechallenges and desensitization may be required for the management of this syndrome.

Conclusion: MDIS occurs by a nonimmune mechanism which requires a prompt withdrawal of the offending drug(s), and in some cases may require drug re-challenge and desensitization.

Keywords: Multiple drug intolerance syndrome, antibiotics, hypersensitivity, immunological reactions, floctafenine, pyrazolones.

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[1]
Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy 2014; 69(4): 420-37.
[http://dx.doi.org/10.1111/all.12350] [PMID: 24697291]
[2]
Schiavino D, Nucera E, Roncallo C, et al. Multiple-drug intolerance syndrome: clinical findings and usefulness of challenge tests. Ann Allergy Asthma Immunol 2007; 99(2): 136-42.
[http://dx.doi.org/10.1016/S1081-1206(10)60637-0] [PMID: 17718101]
[3]
Chiriac AM, Demoly P. Multiple drug hypersensitivity syndrome. Curr Opin Allergy Clin Immunol 2013; 13(4): 323-9.
[http://dx.doi.org/10.1097/ACI.0b013e3283630c36] [PMID: 23799329]
[4]
Macy E, Ho NJ. Multiple drug intolerance syndrome: prevalence, clinical characteristics, and management. Ann Allergy Asthma Immunol 2012; 108(2): 88-93.
[http://dx.doi.org/10.1016/j.anai.2011.11.006] [PMID: 22289726]
[5]
Sullivan T. Studies of the multiple drug allergy syndrome. J Allergy Clin Immunol 1989; 83: 270.
[6]
Peter J. Multiple-drug intolerance syndrome. J Allergy Clin Immunol 2016; 29: 152-6.
[7]
Pichler WJ, Daubner B, Kawabata T. Drug hypersensitivity: flare-up reactions, cross-reactivity and multiple drug hypersensitivity. J Dermatol 2011; 38(3): 216-21.
[http://dx.doi.org/10.1111/j.1346-8138.2010.01142.x] [PMID: 21342222]
[8]
Asero R, Tedeschi A, Lorini M. Autoreactivity is highly prevalent in patients with multiple intolerances to NSAIDs. Ann Allergy Asthma Immunol 2002; 88(5): 468-72.
[http://dx.doi.org/10.1016/S1081-1206(10)62384-8] [PMID: 12027067]
[9]
Robinson JL, Hameed T, Carr S. Practical aspects of choosing an antibiotic for patients with a reported allergy to an antibiotic. Clin Infect Dis 2002; 35(1): 26-31.
[http://dx.doi.org/10.1086/340740] [PMID: 12060871]
[10]
Antoniou S, Saxena M, Hamedi N, et al. Management of hypertensive patients with multiple drug intolerances: A single-center experience of a novel treatment algorithm. J Clin Hypertens (Greenwich) 2016; 18(2): 129-38.
[http://dx.doi.org/10.1111/jch.12637] [PMID: 26306794]
[11]
Omer HMRB, Hodson J, Thomas SK, Coleman JJ. Multiple drug intolerance syndrome: a large-scale retrospective study. Drug Saf 2014; 37(12): 1037-45.
[http://dx.doi.org/10.1007/s40264-014-0236-x] [PMID: 25362509]
[12]
Okeahialam BN. Multidrug intolerance in the treatment of hypertension: result from an audit of a specialized hypertension service. Ther Adv Drug Saf 2017; 8(8): 253-8.
[http://dx.doi.org/10.1177/2042098617705625] [PMID: 28781737]
[13]
Blumenthal KG, Li Y, Acker WW, et al. Multiple drug intolerance syndrome and multiple drug allergy syndrome: Epidemiology and associations with anxiety and depression. Allergy 2018; 73(10): 2012-23.
[http://dx.doi.org/10.1111/all.13440] [PMID: 29574787]
[14]
Patriarca G, Schiavino D, Nucera E, Colamonico P, Montesarchio G, Saraceni C. Multiple drug intolerance: allergological and psychological findings. J Investig Allergol Clin Immunol 1991; 1(2): 138-44.
[PMID: 1669570]
[15]
De Pasquale T, Nucera E, Boccascino R, et al. Allergy and psychologic evaluations of patients with multiple drug intolerance syndrome. Intern Emerg Med 2012; 7(1): 41-7.
[http://dx.doi.org/10.1007/s11739-011-0510-1] [PMID: 21259055]
[16]
Morais-Almeida M, Marinho S, Rosa S, Gaspar A, Rosado-Pinto JE. Multiple drug intolerance including etoricoxib. Allergy 2006; 61(1): 144-5.
[http://dx.doi.org/10.1111/j.1398-9995.2005.00878.x] [PMID: 16364172]
[17]
Pichler WJ, Srinoulprasert Y, Yun J, Hausmann O. Multiple drug hypersensitivity. Int Arch Allergy Immunol 2017; 172(3): 129-38.
[http://dx.doi.org/10.1159/000458725] [PMID: 28315874]
[18]
Asero R, Tedeschi A, Lorini M, Caldironi G, Barocci F. Sera from patients with multiple drug allergy syndrome contain circulating histamine-releasing factors. Int Arch Allergy Immunol 2003; 131(3): 195-200.
[http://dx.doi.org/10.1159/000071486] [PMID: 12876410]
[19]
Romano A, Guéant-Rodriguez R-M, Viola M, Gaeta F, Caruso C, Guéant J-L. Cross-reactivity among drugs: clinical problems. Toxicology 2005; 209(2): 169-79.
[http://dx.doi.org/10.1016/j.tox.2004.12.016] [PMID: 15767031]
[20]
Aberer W, Bircher A, Romano A, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003; 58(9): 854-63.
[http://dx.doi.org/10.1034/j.1398-9995.2003.00279.x] [PMID: 12911412]
[21]
Gangemi S, Guarneri C, Romeo P, Guarneri F. Safety and reliability of the drug tolerance test: our experience in 739 patients. Pharmacology 2011; 87(1-2): 90-5.
[http://dx.doi.org/10.1159/000323227] [PMID: 21242716]
[22]
http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2011 02554.x/abstract
[23]
Ramam M, Bhat R, Jindal S, et al. Patient-reported multiple drug reactions: clinical profile and results of challenge testing. Indian J Dermatol Venereol Leprol 2010; 76(4): 382-6.
[http://dx.doi.org/10.4103/0378-6323.66587] [PMID: 20657119]
[24]
Nettis E, Colanardi MC, Paola RD, Ferrannini A, Tursi A. Tolerance test in patients with multiple drug allergy syndrome. Immunopharmacol Immunotoxicol 2001; 23(4): 617-26.
[http://dx.doi.org/10.1081/IPH-100108607] [PMID: 11792020]
[25]
White A, Ludington E, Mehra P, Stevenson DD, Simon RA. Effect of leukotriene modifier drugs on the safety of oral aspirin challenges. Ann Allergy Asthma Immunol 2006; 97(5): 688-93.
[http://dx.doi.org/10.1016/S1081-1206(10)61101-5] [PMID: 17165280]
[26]
Asero R. Clinical management of adult patients with a history of nonsteroidal anti-inflammatory drug-induced urticaria/angioedema: update. Allergy Asthma Clin Immunol 2007; 3(1): 24-30.
[http://dx.doi.org/10.1186/1710-1492-3-1-24] [PMID: 20525150]
[27]
Asero R. Oral aspirin challenges in patients with a history of intolerance to single non-steroidal anti-inflammatory drugs. Clin Exp Allergy 2005; 35(6): 713-6.
[http://dx.doi.org/10.1111/j.1365-2222.2005.2228.x] [PMID: 15969659]
[28]
Asero R. Use of ketoprofen oral challenges to detect cross-reactors among patients with a history of aspirin-induced urticaria. Ann Allergy Asthma Immunol 2006; 97(2): 187-9.
[http://dx.doi.org/10.1016/S1081-1206(10)60011-7] [PMID: 16937749]
[29]
Cormican LJ, Farooque S, Altmann DR, Lee TH. Improvements in an oral aspirin challenge protocol for the diagnosis of aspirin hypersensitivity. Clin Exp Allergy 2005; 35(6): 717-22.
[http://dx.doi.org/10.1111/j.1365-2222.2005.02261.x] [PMID: 15969660]
[30]
Macy E, Bernstein JA, Castells MC, et al. Aspirin challenge and desensitization for aspirin-exacerbated respiratory disease: a practice paper. Ann Allergy Asthma Immunol 2007; 98(2): 172-4.
[http://dx.doi.org/10.1016/S1081-1206(10)60692-8] [PMID: 17304886]
[31]
Warner TD, Giuliano F, Vojnovic I, Bukasa A, Mitchell JA, Vane JR. Nonsteroid drug selectivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. Proc Natl Acad Sci USA 1999; 96(13): 7563-8.
[http://dx.doi.org/10.1073/pnas.96.13.7563] [PMID: 10377455]
[32]
Asero R. Intolerance to nonsteroidal anti-inflammatory drugs might precede by years the onset of chronic urticaria. J Allergy Clin Immunol 2003; 111(5): 1095-8.
[http://dx.doi.org/10.1067/mai.2003.1444] [PMID: 12743575]
[33]
Yager N, Wang K, Keshwani N, Torosoff M. Phenytoin as an effective treatment for polymorphic ventricular tachycardia due to QT prolongation in a patient with multiple drug intolerances BMJ Case Rep 2015; 2015bcr2015209521
[http://dx.doi.org/10.1136/bcr-2015-209521] [http://dx.doi.org/10.1136/bcr-2015-209521] [PMID: 26071440]

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