Contact Hours: 3
This educational activity is credited for 3 contact hours at completion of the activity.
Course Purpose
The purpose of this course is to provide healthcare professionals with a brief overview of side effects, adverse effects, and allergic reactions, and the differences between them, while also discussing nursing considerations to mitigate complications of adverse effects and allergic reactions.
Overview
For healthcare providers, recognizing and differentiating between side effects, adverse effects, and allergic reactions is a crucial skill when treating individuals who may experience various forms of reactions to medical interventions. This course examines side effects and adverse reactions and side effects, their physiological effects, symptoms, and treatment options. This course also discusses critical nursing considerations and the importance of patient education in mitigating the complications of adverse effects and allergic reactions.
Course Objectives
Upon completion of this course, the learner will be able to:
- Define side effects, adverse effects, and allergic reactions.
- Differentiate between side effects, adverse effects, and allergic reactions.
- Recognize common treatment options for allergic reactions and anaphylaxis.
- Understand the physiological response to an allergen.
- Review nursing considerations for side effects, adverse effects, and allergic reactions.
Policy Statement
This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.
Disclosures
Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.
To access Side Effects, Adverse Effects and Allergic Reactions: Understanding the Difference, purchase this course or a Full Access Pass.
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To access Side Effects, Adverse Effects and Allergic Reactions: Understanding the Difference, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
| Bullying | A distinctive pattern of repeatedly and deliberately harming and humiliating others, especially those who are smaller, weaker, younger, or more vulnerable. |
| Cyberbullying | The act of intentionally and consistently mistreating or harassing someone through electronic devices or other forms of electronic communication. |
| Death Threats | A threat, often made anonymously, by one person or a group of people to kill another person or group of people. |
| Depression | A mood disorder that causes a persistent feeling of sadness and loss of interest. |
| Explicit Bullying | Behaviors that are obvious and easily observed by others. |
| Gang-Up | Uniting in opposition to someone or something. |
| HCAHPS Patient Satisfaction Scores | The first national standard for patient satisfaction measurement, according to the Centers for Medicare and Medicaid Services (CMS). |
| Horizontal Hostility | Occurs between groups with whom one would expect to have close affinities. |
| Implicit Bullying | Refers to subtle or indirect forms of mistreatment or aggression that may not be immediately obvious but can still cause harm. |
| Incivility | A general term for social behavior lacking in civility or good manners. |
| Lateral Violence | Also referred to as horizontal violence or bullying, lateral violence is defined as non-physical, aggressive, hostile, and/or harmful behavior between coworkers. |
| Microaggressions | A subtle, often unintentional, form of prejudice that often takes the shape of an offhand comment, an inadvertently painful joke, or a pointed insult. |
| Nurse Bullying | A frequent problem that affects nurses’ productivity, morale, and health. |
| Perpetrator | A person who conducts a harmful, illegal, or immoral act. |
| Physical Behavior | Physical qualities, actions, or things relate to a person’s body, rather than with their mind. |
| Relational Aggression | A type of aggression in which harm is caused by damaging someone’s relationships or social status. |
| Self-Harm | Also known as non-suicidal self-injury (NSSI), occurs when someone hurts themself directly and intentionally, but without the goal of ending your life. |
| Social Exclusion | The social disadvantage and relegation to the fringe of society. |
| Stereotyping | A kind of mental shortcut that we all use to categorize and evaluate people, places, and things. |
| Suicide | Taking you own life. |
| Supernurse | Extraordinary powers used for good; cloak of invulnerability; no sidekick; Kryptonite, and an alter ego. |
| Post-Traumatic Stress Disorder | A mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback, and avoidance of similar situations. |
| Transgressor | A verb that means to violate a command or law, to go beyond a limit or boundary, or to pass beyond or go over a limit or boundary. |
| Two-Faced | An adjective that describes someone who is not sincere and says unpleasant things while seeming to be pleasant. |
| Verbal Abuse | A type of emotional abuse where a person uses their words to manipulate and control the other person. |
For healthcare providers, recognizing and differentiating between side effects, adverse effects, and allergic reactions is a crucial skill when treating individuals who may experience various forms of reactions to medical interventions. Side effects are predictable, unintended consequences of a drug experienced by patients in varying degrees. 1 In contrast, adverse effects are unexpected, harmful reactions to a drug that may require medical intervention. 1 Both side effects and adverse effects are an inherent aspect of many medical treatments, but the severity and occurrence depend on individual factors and drug interactions.
Conversely, an allergic reaction is an exaggerated and abnormal immune response triggered by the presence of specific substances, often referred to as allergens. These reactions can manifest as a broad range of symptoms, from mild skin irritations to severe anaphylaxis, a life-threatening condition.2 Recognizing an allergic reaction requires a distinct set of skills, as it involves identifying the allergen responsible and managing the immune response. Side effects and allergic reactions can have a considerable impact on an individual’s quality of life, leading to missed school or workdays, reduced productivity, and impaired daily activities. Efforts to manage and address these reactions have been a primary goal of clinical research around the world to improve both medications and treatment options.1,2 This course examines side effects and adverse reactions and side effects, their physiological effects, symptoms, and treatment options. This course also discusses critical nursing considerations and the importance of patient education in mitigating the complications of adverse effects and allergic reactions.
An allergic reaction, medically referred to as hypersensitivity or allergic hypersensitivity, is an exaggerated and aberrant immune response mounted by the body against a substance that is normally considered harmless. This response is triggered by the recognition of specific antigens, known as allergens, by the immune system. Allergic reactions are a complex interplay of immunological events that can manifest in various forms and severity, ranging from mild, localized symptoms to life-threatening systemic reactions.2
The pathway of an allergic reaction starts with an initial exposure to an allergen. This agent primes the immune system to recognize and remember it. During this phase, allergen-specific immune cells, such as T cells and B cells, become sensitized and produce allergen-specific antibodies, particularly immunoglobulin E (IgE). Upon re-exposure to the same allergen, the allergen specific IgE antibodies are activated, binding them to immune cells called mast cells and basophils, which are found throughout the body. This binding sensitizes these cells and primes them for activation.3,4
Subsequent exposure to the allergen triggers IgE antibodies on mast cells and basophils, leading to the release of inflammatory mediators, such as histamine and leukotrienes, which initiate the inflammatory response. The release of these mediators induces a cascade of events, resulting in increased blood vessel permeability, smooth muscle contraction, and immune cell recruitment to the affected site, leading to the classic symptoms of an allergic reaction, such as swelling, redness, itching, and in some cases, systemic symptoms like hives, sneezing, or anaphylaxis.
Classifications of Allergic Reactions
Allergic reactions can be classified based on the underlying immune mechanisms involved and can be divided into four main types: Type I, Type II, Type III, and Type IV.2,3,4
- Type I Hypersensitivity (IgE-Mediated)
- This is the most well-known allergic reaction and is mediated by immunoglobulin E (IgE) antibodies. Sensitization occurs when an individual is exposed to an allergen, and their immune system produces allergen specific IgE antibodies. Re-exposure to the allergen activates the IgE antibodies on mast cells and basophils, causing the release of inflammatory mediators, primarily histamine. Type I reactions are responsible for immediate, localized allergic symptoms.2,5
- Type II Hypersensitivity (Cytotoxic Hypersensitivity)
- Type II hypersensitivity involves antibodies, typically IgM or IgG, binding to antigens on the surface of target cells, leading to their destruction. This can occur through complement activation or antibody-dependent cell-mediated cytotoxicity (ADCC). Examples of Type II reactions include hemolytic transfusion reactions, autoimmune diseases like autoimmune hemolytic anemia, and drug-induced immune cytopenias.2,
- Type III Hypersensitivity (Immune Complex-Mediated)
- In Type III hypersensitivity, immune complexes, formed by the binding of antibodies (usually IgG) to soluble antigens, are deposited in various tissues, leading to an inflammatory response. Examples include conditions like systemic lupus erythematosus (SLE), rheumatoid arthritis, and certain forms of vasculitis.2,5
- Type IV Hypersensitivity (Delayed-Type Hypersensitivity)
- Unlike the immediate reactions seen in the previous types, Type IV hypersensitivity is characterized by a delayed immune response, which primarily involves T cells. Sensitization involves the activation of T cells in response to an antigen, which takes time to develop. This type leads to a delayed, cell-mediated response. Examples include contact dermatitis such as poison ivy reaction, granulomatous diseases as in tuberculosis, and organ transplant rejection.2,5
The inflammatory response is a fundamental physiological process that the body initiates to protect itself from harmful stimuli and promote healing and tissue repair. The mechanism of action of the inflammatory response can be described in several key steps. 6,7
1. Recognition of the Stimulus and Release of Inflammatory Mediators
- The inflammatory response is triggered when immune cells, particularly macrophages and dendritic cells, recognize a harmful stimulus such as a pathogen, tissue damage or the existence of foreign substances such as allergens. These immune cells release signaling molecules called cytokines (interleukins and tumor necrosis factor (TNF)) and other inflammatory mediators, including prostaglandins and leukotrienes. These mediators serve as messengers to communicate with other immune cells and orchestrate the inflammatory response.6,7
2. Vasodilation and Increased Vascular Permeability
- One of the immediate effects of these inflammatory mediators is the dilation of blood vessels in the affected area. This process, known as vasodilation, increases blood flow to the site of injury or infection. The increased blood flow delivers more immune cells and oxygen to the area to further facilitate the immune response. Also, blood vessel walls become more permeable, allowing fluids, proteins, and immune cells to move from the bloodstream into the tissues. This increased vascular permeability contributes to the characteristic swelling and redness associated with inflammation.6,7
3. Immune Cell Recruitment, Phagocytosis, and Tissue Repair
- Immune cells, particularly neutrophils and macrophages, are attracted to the site of inflammation by chemotactic signals released by damaged tissues and other immune cells. These cells are responsible for phagocytosis, the process of engulfing and destroying pathogens or cellular debris. This process helps eliminate the source of the inflammation. Simultaneously, other immune cells, such as T lymphocytes, help regulate the immune response and facilitate tissue repair and healing.6,7
4. Resolution of Inflammation and Tissue Regeneration
- As the threat is neutralized and the healing process progresses, the inflammatory response is actively resolved. Anti-inflammatory mediators, like interleukin-10 and transforming growth factor-beta (TGF-β), help dampen the immune response, reduce inflammation, and promote tissue repair. Once the threat is eliminated, the body initiates tissue regeneration and repair mechanisms, including the proliferation and differentiation of cells necessary for tissue healing.6,7
Symptoms of an allergic reaction can present in several ways and differ in intensity, depending on the allergen and an individual’s sensitivity. Common symptoms typically involve the respiratory, skin, gastrointestinal, and cardiovascular systems. These may include sneezing, runny or stuffy nose, itchy or watery eyes, skin rashes or hives, swelling of the lips, tongue, or face, abdominal cramping, nausea, vomiting, and diarrhea. Children may exhibit behavior changes such as clinging, crying, becoming irritable, and ceasing to play. 2,3,4
In serious cases, individuals may have difficulty breathing, start wheezing, or present with a sudden drop in blood pressure. Some allergic reactions may also involve systemic symptoms, such as a feeling of impending doom or a sense of anxiety. In the most severe cases, a life-threatening condition known as anaphylaxis occurs. 2,3,4
Anaphylaxis is the most severe form of a hypersensitivity reaction characterized by its rapid onset, occurring within minutes to hours of exposure to an allergen. This extreme reaction is initiated by the activation of mast cells and basophils via the binding of cell membrane receptors to IgE antibodies. This cell activation leads to the release of various mediators from secretory granules. As the reaction progresses, secondary substances come into play that generate severe complications, including bronchoconstriction, increased vascular permeability, and facial flushing. This rapid progression can be life-threatening and may lead to fatality without prompt intervention.8
Common treatment options for allergic reactions typically depend on the type and severity of the reaction. Common medications include antihistamines, epinephrine, corticosteroids, decongestants, and allergen-specific immunotherapy.2,3,8
Antihistamines
Antihistamines work by blocking the effects of histamine, a key mediator in allergic responses. They can help relieve itching, hives, sneezing, and runny nose, but they may be less effective for severe allergic reactions like anaphylaxis.9,10
Epinephrine
Epinephrine is the first-line treatment for anaphylaxis. It acts rapidly to constrict blood vessels, relax airway muscles, and reduce swelling, helping to reverse severe symptoms like difficulty breathing, swelling, and a drop in blood pressure.8,11
Corticosteroids
Corticosteroids work by suppressing the immune system’s response to allergens and reducing inflammation. They are frequently prescribed for moderate to severe allergic reactions. They are particularly helpful in cases of contact dermatitis or systemic reactions.12,13
Decongestants
Decongestants help reduce nasal congestion by narrowing blood vessels in the nasal passages. They are commonly used for allergies causing sinus congestion or rhinitis, as opposed to allergic reactions caused by medications.14,15
Allergen-Specific Immunotherapy
Also known as allergy shots, allergen-specific immunotherapy involves injecting gradually increasing doses of allergens under medical supervision. Over time, this treatment can help desensitize individuals to allergens and reduce their allergic responses.16
Side Effects vs Adverse Reactions
In healthcare the terms “side effects” and “adverse reactions” denote distinct aspects of a drug’s impact on the body. Side effects refer to unintended but typically predictable outcomes of a medication that accompany a medication’s primary pharmacological action. These side effects may be beneficial, neutral, or harmful and range from mild to more severe manifestations. Examples include drowsiness from antihistamines or gastrointestinal upset from non-steroidal anti-inflammatory drugs.17,18
On the other hand, adverse reactions signify unintended and harmful responses to a medication, explicitly suggesting a negative impact on the patient’s health. While some adverse reactions may be predictable based on a medication’s pharmacology, others are idiosyncratic and unpredictable, often being more severe than typical side effects. Instances include liver damage, or serious skin rashes like Stevens-Johnson syndrome. While this may sound like an allergic reaction, adverse reaction and allergic reactions are not the same thing.19
Adverse reactions are a broader category that encompasses any harmful and unintended response to a medication or treatment, regardless of the underlying mechanism. Allergic reactions specifically involve the body’s immune system responding abnormally to an allergen. Regardless, both adverse and allergic demand closer monitoring, intervention, and may necessitate discontinuation of the medication to ensure patient safety.18,19
To better understand the difference between an allergic reaction and side effects, the widely used over the counter medication, acetaminophen (Tylenol) will be used as an example. Generally considered a safe medication, acetaminophen use can potentially cause an allergic reaction or cause side effects in individuals. Though they tend to be relatively rare, common side effects of acetaminophen may include nausea and mild stomach discomfort.20,21 This manifestation is unintended, but is known as acetaminophen has been shown to irritate the stomach lining in some individuals, such as those who take the medication on an empty stomach or are prone to experiencing gastrointestinal side effects with most medications.
Common treatments for reducing side effects are typically aimed at managing and alleviating specific symptoms or that may occur. Depending on the nature and severity of the side effects, various approaches can be considered. For example, individuals with nausea or stomach discomfort can be given over-the-counter medications such as non-prescription pain relievers, antacids to neutralize stomach acid, acid reducers to reduce stomach acid production, or anti-nausea medications. Alternatively, patients can be advised to take medication with food or milk to reduce the risk of stomach discomfort.21
In some cases, adjusting the dosage of the medication may be a suitable approach to managing side effects. Changing the dosing schedule or reducing the dose can help minimize side effects while maintaining the therapeutic benefits of the medication. Alternatively, a second medication may be prescribed to counteract or mitigate side effects. For instance, if acetaminophen causes constipation, a laxative might be recommended to manage this issue. However, if the side effects are severe or intolerable, healthcare providers may consider switching to an alternative medication with a similar therapeutic effect but, a different chemical structure.21,22
Note that liver or kidney damage are not a side effect of acetaminophen. Rather it is an adverse reaction, an unintended and harmful reaction resulting from the prolonged use or high doses of acetaminophen, which is metabolized by the liver and passed through the kidney.
Symptoms of liver issues may include jaundice (yellowing of the skin or eyes), dark urine, and unusual fatigue.17,18 While symptoms of kidney problems include fatigue, swelling, changes in urine color or frequency, persistent itching, and unexplained shortness of breath. If a patient is presenting with such complications, close monitoring is necessary through blood tests and regular check-ups, and issues should be addressed promptly with suitable interventions to prevent further deterioration and ensure optimal patient outcomes.22
Allergic reactions to acetaminophen are relatively rare but may occur, varying widely in their severity.21 These are the unintended, immune system responses that need to be treated immediately to halt the excessive inflammatory response. Potential allergic reactions to acetaminophen may include skin reactions such as hives (raised, itchy welts on the skin) or a skin rash. In some cases, it may lead to severe blistering and peeling.20 Swelling, typically of the face, lips, tongue, or throat, may occur. Severe swelling can be especially concerning if it affects the airway resulting in difficulty breathing, wheezing, or shortness of breath, which may indicate a more severe allergic response. In rare cases, an allergic reaction to acetaminophen can progress to anaphylaxis, a medical emergency.24,26
For mild allergic reactions, over-the-counter antihistamines, such as diphenhydramine (commonly known as Benadryl), can be beneficial in alleviating symptoms like hives or itching. In instances of severe allergic reactions, healthcare providers may prescribe corticosteroids. For life-threatening anaphylactic reactions, epinephrine remains the primary and immediate treatment. For severe to life-threatening cases, supportive care may be necessary. This can include treatments such as intravenous fluids and oxygen to stabilize the individual’s condition.24,25,26
Nurses play a principal role in patient care and medication management, and their ability to discern these different drug-related situations is crucial for patient safety in several ways, as explained below.
1. Assessments and Evaluations
- To identify allergic reactions, nurses should conduct a thorough assessment of the patient, including their medical history, allergies, and current medication regimen. Continuous monitoring of the patient is essential, looking for signs such as hives, skin rashes, itching, facial swelling, or breathing difficulties. Effective communication with the patient is key, as they may provide valuable information about new symptoms or discomfort that correlates with medication administration.
- In the case of side effects, nurses should regularly assess the patient for any signs or symptoms indicative of common side effects. Even if the symptoms are mild, it is essential to take notice of them. If the side effects persist or worsen, nurses may need to conduct a more comprehensive assessment and potentially consult with the advanced practice provider to consider medication adjustments.
- For adverse effects, nurses must remain vigilant for unexpected changes in the patient’s condition, such as severe gastrointestinal distress, organ dysfunction, or unusual bleeding tendencies. A thorough medication history review, including over-the-counter drugs and herbal supplements, is important to detect potential adverse effects stemming from drug interactions. In cases where medications require regular laboratory tests, nurses should ensure these tests are ordered and monitor the results closely to detect adverse effects.
2. Treatment Strategies
- For allergic reactions, the nurse’s immediate response should involve discontinuing the medication and ensuring the patient’s airway is clear. If indicated, epinephrine should be administered, followed by antihistamines and corticosteroids. Emergency measures should be initiated in the presence of anaphylaxis.
- Mild side effects can be managed by reassuring the patient and offering supportive care as needed. In cases of persistent or severe side effects, adjustments to the treatment plan may be necessary.
- For adverse effects, discontinuing the problematic medication may be necessary. Close monitoring of the patient’s condition and implementation of appropriate interventions based on the specific adverse effect and its severity are essential.
- Documentation
- In all these situations, accurate documentation is an essential nursing objective as it provides a comprehensive overview of the patient’s response to the medication, including the timing of the reaction, its severity, and the interventions taken. This facilitates effective coordination within the healthcare team, which is indispensable for achieving optimal outcomes when addressing allergic reactions, side effects, or adverse effects to medications.
Patient Education
Nurses must educate patients about potential side effects and adverse reactions, enabling patients to recognize them better and report them promptly. Medication education increases early detection and intervention as it includes explaining the benefits and potential risks. When patients understand the reasons behind their treatment and the potential side effects, they are more likely to adhere to their medication regimens. This, in turn, enhances the effectiveness of treatment and reduces the risk of adverse effects resulting from non-compliance.1,2
Nurses who contribute to fostering this empowerment promote better health outcomes. When patients have all the information, they become empowered to participate in their care actively. They are more likely to engage in meaningful discussions with their healthcare providers, ask questions, and express concerns. Also, with the correct vocabulary, patients can effectively communicate with their healthcare providers. This encourages more meaningful exchanges, better patient-provider relationships, and improved patient care.1,2 Furthermore, nurses who take the time to educate their patients help mitigate anxiety. Many patients experience anxiety or fear when prescribed new medications or when they experience side effects. Nurses provide clear and accurate information to alleviate these emotions and reassure patients about their treatment plans.1,2
In healthcare, understanding the distinctions between side effects, adverse effects, and allergic reactions is an indispensable skill for healthcare providers in ensuring the safety and well-being of patients. These reactions are an inherent part of medical interventions and can significantly impact an individual’s quality of life. Side effects, often an expected outcome of treatments, may vary in severity and can often be managed with supportive care or adjustments in the treatment plan. Adverse effects require vigilant monitoring and may demand discontinuation of the medication and the initiation of appropriate interventions. Allergic reactions, especially anaphylaxis, necessitate immediate action and the administration of treatments like epinephrine.
It is worth noting that acetaminophen, commonly known as Tylenol, is a widely used over-the-counter medication for pain relief and fever reduction. While relatively safe, acetaminophen, like all medications, can have side effects and cause allergic reactions. For this reason, patient education is imperative to ensure they are aware and informed of potential reactions to medications that are prescribed. Nurses are fundamental players in patient education. Ultimately, informed patients and vigilant care lead to improved health outcomes, patient safety and well-being and a higher quality of life.
- Coleman, J. J., & Pontefract, S. K. (2016). Adverse drug reactions. Clinical Medicine, 16(5), 481-485. https://doi.org/10.7861/clinmedicine.16-5-481
- deShazo, R. D., & Kemp, S. F. (1997). Allergic reactions to drugs and biologic agents. JAMA, 278(22), 1895–1906. https://pubmed.ncbi.nlm.nih.gov/9396651/
- Meggs, W. J. (1999). Mechanisms of allergy and chemical sensitivity. Toxicology and Industrial Health, 15(3-4), 331–338. https://doi.org/10.1177/074823379901500307
- Barnes, P. J. (2011). Pathophysiology of allergic inflammation. Immunological Reviews, 242(1), 31–50. https://doi.org/10.1111/j.1600-065x.2011.01020.x
- Fischer, D., Vander Leek, T. K., Ellis, A. K., & Kim, H. (2018). Anaphylaxis. Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2). https://doi.org/10.1186/s13223-018-0283-4
- Megha, KB., Joseph, X., Akhil, V., & Mohanan, PV. (2021). Cascade of immune mechanism and consequences of inflammatory disorders. Phytomedicine, 91, 153712. https://doi.org/10.1016/j.phymed.2021.153712
- Sherwood, E. R., & Toliver-Kinsky, T. (2004). Mechanisms of the inflammatory response. Best Practice & Research Clinical Anaesthesiology, 18(3), 385-405. https://doi.org/10.1016/j.bpa.2003.12.002
- Mota, I., Gaspar, Â., Benito-Garcia, F., Correia, M., Chambel, M., & Morais-Almeida, M. (2018). Drug-induced anaphylaxis: Seven-year single-center survey. European Annals of Allergy and Clinical Immunology, 50(05), 211. https://doi.org/10.23822/eurannaci.1764-1489.66
- Kar, S., Krishnan, A., Preetha, K., & Mohankar, A. (2012). A review of antihistamines used during pregnancy. Journal of Pharmacology & Pharmacotherapeutics, 3(2), 105-108. https://doi.org/10.4103/0976-500X.95503
- Geiger, T. L., & Howard, S. C. (2006). Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Non-hemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice? Transfusion Medicine Reviews, 21(1), 1. https://doi.org/10.1016/j.tmrv.2006.09.001
- Kemp, S. F., Lockey, R. F., & R Simons, F. E. (2008). Epinephrine: The Drug of Choice for Anaphylaxis–A Statement of the World Allergy Organization. The World Allergy Organization Journal, 1(Suppl 2), S18. https://doi.org/10.1097/1939-4551-1-S2-S18
- Mahlab-Guri, K., Asher, I., & Sthoeger, Z. (2023). Immediate and delayed hypersensitivity reactions to corticosteroids – prevalence, diagnosis, and treatment. Swiss Medical Weekly, 153(2), 40025. https://doi.org/10.57187/smw.2023.40025
- Solà, I., & González, L. E. (2010). Pharmacological interventions for the prevention of allergic and febrile non‐haemolytic transfusion reactions. The Cochrane Database of Systematic Reviews, 2010(6). https://doi.org/10.1002/14651858.CD007539.pub2
- Hendeles, L. (1993). Selecting a decongestant. Pharmacotherapy, 13(6 Pt 2), 129S134S; discussion 143S-146S. https://pubmed.ncbi.nlm.nih.gov/7507590
- Meltzer, E. O., Casale, T. B., Gold, M. S., O’Connor, R., Reitberg, D., del Rio, E., Weiler, J. M., & Weiler, K. (2003). Efficacy and safety of clemastine-pseudoephedrine-acetaminophen versus pseudoephedrine-acetaminophen in the treatment of seasonal allergic rhinitis in a 1-day, placebo-controlled park study. Annals of Allergy, Asthma & Immunology, 90(1), 79–86. https://doi.org/10.1016/s1081-1206(10)63618-6
- Moote, W., Kim, H., & Ellis, A. K. (2018). Allergen-specific immunotherapy. Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2). https://doi.org/10.1186/s13223-018-0282-5
- Coleman, J. J., & Pontefract, S. K. (2016). Adverse drug reactions. Clinical Medicine, 16(5), 481-485. https://doi.org/10.7861/clinmedicine.16-5-481
- Practitioners, T. R. A. C. of G. (n.d.). RACGP – Adverse drug reactions – Allergy? Side-effect? Intolerance? Www.racgp.org.au. https://www.racgp.org.au/afp/2013/januaryfebruary/adverse-drug-reactions/
- Edwards, I. R., & Aronson, J. K. (2000). Adverse drug reactions: definitions, diagnosis, and management. Lancet (London, England), 356(9237), 1255–1259. https://doi.org/10.1016/S0140-6736(00)02799-9
- Orandi, B. J., McLeod, M. C., MacLennan, P. A., Lee, W. M., Fontana, R. J., Karvellas, C. J., McGuire, B. M., Lewis, C. E., Terrault, N. M., & Locke, J. E. (2023). Association of FDA Mandate Limiting Acetaminophen (Paracetamol) in Prescription Combination Opioid Products and Subsequent Hospitalizations and Acute Liver Failure. JAMA, 329(9), 735-744. https://doi.org/10.1001/jama.2023.1080
- Johnson, J. (n.d.). Acetaminophen Extended-release tablets For The Temporary Relief https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/019872Orig1s048lbl.pdf
- Li, M., Luo, Q., Tao, Y., Sun, X., & Liu, C. (2021). Pharmacotherapies for Drug-Induced Liver Injury: A Current Literature Review. Frontiers in Pharmacology, 12. https://doi.org/10.3389/fphar.2021.806249
- https://www.fda.gov/drugs/drug-safety-and-availability/questions-and-answers-fda-warns-rare-serious-skin-reactions-pain-relieverfever-reducer-acetaminophen
- Sunwoo, J., Kim, H., & Bae, S. (2021). Acetaminophen-induced anaphylaxis: A case report. Translational and Clinical Pharmacology, 29(2), 88-91. https://doi.org/10.12793/tcp.2021.29.e8
- Ramachandran, A., & Jaeschke, H. (2018). Acetaminophen Toxicity: Novel Insights Into Mechanisms and Future Perspectives. Gene Expression, 18(1), 19-30. https://doi.org/10.3727/105221617X15084371374138
- Gabrielli, S., Langlois, A., & Ben-Shoshan, M. (2018). Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis. International Archives of Allergy and Immunology, 176(2), 106–114. https://doi.org/10.1159/000487556
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