From the Guidelines
Id reactions should be managed by treating the primary infection and using topical corticosteroids, such as triamcinolone 0.1% cream, applied twice daily for 1-2 weeks, to control the secondary dermatitis. The primary infection should be addressed with appropriate antibiotics, antifungals, or antivirals based on the causative organism [no direct evidence provided in the question]. For more severe or widespread reactions, a short course of oral prednisone may be necessary, starting at 40-60mg daily and tapering over 2 weeks 1. Antihistamines such as cetirizine 10mg daily can help control itching, and cool compresses and emollients provide symptomatic relief.
Key Considerations
- The id reaction occurs due to a delayed hypersensitivity response to antigens from the primary infection site that circulate and trigger inflammation elsewhere.
- Once the primary infection resolves, the id reaction typically improves, though it may take several days to weeks for complete resolution.
- Treatment should focus on addressing both the primary infection and the secondary id reaction.
Treatment Options
- Topical corticosteroids: triamcinolone 0.1% cream applied twice daily for 1-2 weeks
- Oral prednisone: starting at 40-60mg daily and tapering over 2 weeks for more severe reactions
- Antihistamines: cetirizine 10mg daily to control itching
- Cool compresses and emollients for symptomatic relief
Note: The provided evidence 1 does not directly address id reactions, but the general principles of managing hypersensitivity reactions can be applied.
From the Research
Id Reaction High Points
- Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult 2
- They can be caused by various fungal, bacterial, viral, and parasitic infections, with superficial fungal infections being the most common cause 2
- Clinical presentations of id reactions include:
- Localized or widespread vesicular lesions
- Maculopapular or scarlatiniform eruptions
- Erythema nodosum
- Erythema multiforme
- Erythema annulare centrifugum
- Sweet's syndrome
- Guttate psoriasis
- Autoimmune bullous disease 2
- The mechanisms underlying id reactions vary depending on the type of clinical presentation 2
- Therapy involves the identification and adequate treatment of the underlying infection or dermatitis 2
- Antifungal hypersensitivity reactions can be classified according to their latency (immediate or delayed) and clinical phenotype 3
- Id reactions can be related to anaphylaxis, a life-threatening systemic reaction that requires immediate treatment 4, 5
- Management of id reactions and anaphylaxis involves removal of the trigger, administration of epinephrine, and supportive care 4, 5
- Drug interactions can occur during therapy with antimicrobial agents, including macrolides, quinolones, and azoles 6