Reaction to substance test cases

Goal

Have a library of substances and defined case examples of hypersensitivity or propensity to adverse reaction to the substance. The reaction types need to span the spectrum, including immunologic, various signs/symptoms, non-immunologic adverse reactions including idiosyncratic reactions characteristic for a drug.

For each case, need to indicate:

• history of prior reactions (Care Record Entry)
  • evaluation
  • outcome
  • severity
  • treatment
  • manifestations
  • causality assessment
  • involved substance(s)
    • documentation of instance of administered/exposed material

• diagnosis of hypersensitivity to substance (Health Concern)
  • substance(s) involved
    • certainty that correct substance is identified
  • prediction of criticality
    • probability and severity of each manifestation
    • temporality
    • ability to mitigate
    • ability to rescue
  • supporting evidence
  • link to care plan

Types of substances

(reaction type(s) in parenthesis)

Drugs

• codeine (fixed drug reaction, vomiting, urticaria)
• oxycodone (vomiting, urticaria, sedation)
• fentanyl (muscle rigidity, sedation, vomiting)
• vecuronium (anaphylaxis)
• succinylcholine (neuromuscular malignant syndrome, prolonged paralysis due to plasma pseudocholinesterase)
• amoxicillin (non-specific viral infection associated rash, anaphylaxis, antibiotic associated diarrhea)
• cephalexin (antibiotic associated diarrhea)
• cefaclor (bleeding, rash)
• pen VK
• pen G
• chloramphenicol (pancytopenia/aplastic anemia)
• trimethoprim/sulfamethoxazole (granulocytopenia, renal injury, erythema multiforme)
• benzathine penicillin
• gentamicin (weakness, renal injury)
• procaine penicillin
• procainamide
• procaine
• lidocaine
• aspirin (triad asthma, anaphylactoid syndrome, upper GI bleeding, epistaxis)

Food items

• monosodium glutamate
• Yellow dye #5
• Red dye #40
• wheat

Plant derived materials

• latex rubber

Non-drug/non-food items found in healthcare setting

• intravenous contrast agent
• topical disinfectant
• medical tape

Animals

• Yellow jacket (wasp) venom
• Cats (atopic rhinitis)
• House dust mites

Environmental

• Bird waste
• Feathers

Household and Industrial Chemicals

• Chromic acid (skin burns)
• Sodium dichromate (contact hypersensitivity)

Microorganism

• Mycoplasma pneumoniae (cold agglutinin hemolytic anemia)

Metals

• Ni (contact hypersensitivity)