WHAT YOU NEED TO KNOW:

What is an adverse drug reaction? An adverse drug reaction is a harmful reaction to a medicine given at the correct dose. The reaction can start soon after you take the medicine, or up to 2 weeks after you stop. An adverse drug reaction can cause serious conditions such toxic epidermal necrolysis (TEN) and anaphylaxis. TEN can cause severe skin damage. Anaphylaxis is a sudden, life-threatening reaction that needs immediate treatment. Ask your healthcare provider for more information on TEN, anaphylaxis, and other serious reactions.

What are the signs and symptoms of an adverse drug reaction?

• Mild symptoms include red, itchy, flaky, or swollen skin. You may have a flat, red area on your skin that is covered with small bumps. You may also have hives.
  
  
• Severe symptoms include skin that blisters or peels, vision problems, and severe swelling or itching. Severe reactions include conditions such as toxic epidermal necrolysis (TEN). Ask your healthcare provider for more information on TEN and other serious conditions.
  
  
• Anaphylaxis symptoms include throat tightness, trouble breathing, tingling, dizziness, and wheezing. Anaphylaxis is a sudden, life-threatening reaction that needs immediate treatment. Anaphylaxis may occur if you exercise after exposure to another trigger, such as after you take an antibiotic.

How is an adverse drug reaction diagnosed? Your healthcare provider will ask about your medical history and allergies. You may need additional testing if you developed anaphylaxis after you were exposed to a trigger and then exercised. This is called exercise-induced anaphylaxis. Medicines can be a trigger. You may also need any of the following:

• A patch test means a small amount of the drug is put on your skin. The area is covered with a patch that stays on for 2 days. Then your healthcare provider will check your skin for a reaction.
  
  
• A skin prick test means a small drop of the drug is put on your forearm and your skin is pricked with a needle. Your healthcare provider will watch for a reaction.
  
  
• An intradermal test means a small amount of liquid containing the drug is put under the surface of your skin. Your healthcare provider will watch for a reaction.
  
  
• A drug provocation test is also known as a challenge test. Your healthcare provider gives you increasing doses of the drug and watches for a reaction.

How is an adverse drug reaction treated?

• Antihistamines decrease mild symptoms such as itching or a rash.
  
  
• Epinephrine is medicine used to treat severe allergic reactions such as anaphylaxis.
  
  
• Steroids reduce inflammation.
  
  
• Desensitization may be done after you have a reaction, if you need to be treated with the drug again. Your healthcare provider will give you small doses of the drug over a few hours. He will treat any allergic reaction that you have. The dose is increased a little at a time until the full dose is reached and the drug stops causing an allergic reaction.

What steps do I need to take for signs or symptoms of anaphylaxis?

• Immediately give 1 shot of epinephrine only into the outer thigh muscle.
  
  
• Leave the shot in place as directed. Your healthcare provider may recommend you leave it in place for up to 10 seconds before you remove it. This helps make sure all of the epinephrine is delivered.
  
  
• Call 911 and go to the emergency department, even if the shot improved symptoms. Do not drive yourself. Bring the used epinephrine shot with you.

What safety precautions do I need to take if I am at risk for anaphylaxis?

• Keep 2 shots of epinephrine with you at all times. You may need a second shot, because epinephrine only works for about 20 minutes and symptoms may return. Your healthcare provider can show you and family members how to give the shot. Check the expiration date every month and replace it before it expires.
  
  
• Create an action plan. Your healthcare provider can help you create a written plan that explains the allergy and an emergency plan to treat a reaction. The plan explains when to give a second epinephrine shot if symptoms return or do not improve after the first. Give copies of the action plan and emergency instructions to family members, work and school staff, and daycare providers. Show them how to give a shot of epinephrine.
  
  
• Be careful when you exercise. If you have had exercise-induced anaphylaxis, do not exercise right after you eat. Stop exercising right away if you start to develop any signs or symptoms of anaphylaxis. You may first feel tired, warm, or have itchy skin. Hives, swelling, and severe breathing problems may develop if you continue to exercise.
  
  
• Carry medical alert identification. Wear medical alert jewelry or carry a card that explains the medication allergy. Healthcare providers need to know that they should not give you this medicine. Ask your healthcare provider where to get these items.
  
  
• Read medicine labels before you use any medicine. Do not take anything that contains the medicine you are allergic to. This includes topical medicines that you put on your skin. Ask a pharmacist if you are not sure.
  
  
• Tell all healthcare providers about your allergy. Always tell your healthcare providers the names of medicines that you are allergic to and the symptoms of your allergic reactions.
  
  
• Ask if you need to avoid other medicines. You may be allergic to other medicines if you had an adverse reaction. Make sure you know the names of other medicines that you should not take.

Call 911 for signs or symptoms of anaphylaxis, such as trouble breathing, swelling in your mouth or throat, or wheezing. You may also have itching, a rash, hives, or feel like you are going to faint.

When should I seek immediate care?

• You have a rash with itchy, swollen, red spots.
  
  
• You have blisters, or your skin is peeling.
  
  
• You have trouble swallowing or your voice sounds hoarse.
  
  
• You have a fast or pounding heartbeat.
  
  
• Your skin or the whites of your eyes turn yellow.

When should I contact my healthcare provider?

• You think you are having an allergic reaction. Contact your healthcare provider before you take another dose of the drug.
  
  
• You have a rash.
  
  
• You have a fever.
  
  
• You have a sore throat or swollen glands. You will feel hard lumps when you touch your throat if your glands are swollen.
  
  
• Your skin itches and becomes red when you are in sunlight.
  
  
• You have questions or concerns about your condition, allergy, or care.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.