Definitions used for diagnosing non-IgE-mediated HSRsa

HSRDiagnostic criteria
Maculopapular rashDelayed onset of rash while on nafcillin treatment with physical exam findings of lesion morphology specifying macules, papules, macular, papular, maculopapular, and morbilliform, with renal and liver function remaining unchanged
Immune-mediated nephritisAcute change in renal function defined as either a 50% change in creatinine or a rise in creatinine of >0.5 mg/dl coinciding temporally with nafcillin treatment with either one of the following: (i) rash or (ii) AEC of >500/ml
Serum sickness-like reactionAt least three of the following classic features, beginning after use of nafcillin and subsiding when the drug is eliminated from the body: (i) rash, (ii) fever, (iii) malaise, (iv) polyarthralgias or polyarthritis, (v) lymphadenopathy, or (vi) low complement
EosinophiliaAEC of >1,000/ml in the absence of other symptoms coinciding temporally with nafcillin treatment, with renal and kidney function remaining unchanged
Immune-mediated hepatitisIncreased liver function tests with an AEC of >500/ml coinciding temporally with nafcillin treatment and with renal function remaining unchanged
  • a Data are from references 1, 9, 20 to 22, and 28 to 34). Abbreviations: HSR, hypersensitivity reaction; AEC, absolute eosinophil count.