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Injection site reactions (ISRs) are reactions that occur at the site of injection of a drug. They may be mild or severe and may or may not require medical intervention. Some reactions may appear immediately after injection, and some may be delayed. [1] Such reactions can occur with subcutaneous, intramuscular, or intravenous administration.
Fixed drug reactions are common and so named because they recur at the same site with each exposure to a particular medication. [1] Medications inducing fixed drug eruptions are usually those taken intermittently.
Unlike type A reactions, the mechanism of type B or hypersensitivity drug reactions is not fully elucidated. However, there is a complex interplay between a patient's inherited genetics, the pharmacotoxicology of the drug and the immune response that ultimately give rise to the manifestation of a drug eruption.
Generalized bullous fixed drug eruption (GBFDE) most commonly refers to a drug reaction in the erythema multiforme group. [3]: 129 These are uncommon reactions to medications, with an incidence of 0.4 to 1.2 per million person-years for toxic epidermal necrolysis and 1.2 to 6.0 per million person-years for Stevens–Johnson syndrome.
The first is a local reaction of itchiness, eczema-like texture, indurated erythema on the skin at the injection site. The second is a generalized reaction that can show up as a skin lesion resembling a cyst. The localized reaction takes 4–14 days to develop and can take months to heal. [12]
Cytokine reaction syndrome may also be induced by certain medications, such as the CD20 antibody rituximab and the CD19 CAR T cell tisagenlecleucel. The experimental drug TGN1412 —also known as Theralizumab—caused extremely serious symptoms when given to six participants in a Phase I trial . [ 2 ]
The Dick test involved injecting a diluted strain of the streptococci known to cause scarlet fever; a reaction in the skin at the injection site identified people susceptible to developing scarlet fever. The reaction could be seen four hours after the injection, but was more noticeable after 24 hours.
The symptoms of DRESS syndrome usually begin 2 to 6 weeks but uncommonly up to 8–16 weeks after exposure to an offending drug. Symptoms generally include fever, an often itchy rash which may be morbilliform or consist mainly of macules or plaques, facial edema (i.e. swelling, which is a hallmark of the disease), enlarged and sometimes painful lymph nodes, and other symptoms due to ...