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Antiretroviral Medication Allergy

Medically reviewed by Last updated on Aug 31, 2022.

What is an antiretroviral medication allergy?

An antiretroviral (ARV) medication allergy is a harmful reaction to an ARV medicine. An allergic reaction may happen when you start a new ARV medicine or after you take the medicine for a few weeks. Your immune system may become sensitive to the ARV medicine the first time you take it. You may have an allergic reaction the next time. You can have a reaction within an hour, or the reaction can happen days or weeks later.

What are the signs and symptoms of an allergic reaction to an ARV medicine?

  • Mild reactions include hot, red, itchy, or swollen skin, or a hard lump where the shot was given. You may have a flat, red area on your skin that is covered with small bumps. You may also have a headache, feel tired or dizzy, or have muscle pain.
  • Severe symptoms include skin that blisters or peels, vision problems, and severe swelling or itching. You may also have yellowing of your skin or whites of your eyes, abdominal pain, or dark urine. Severe reactions include conditions such as toxic epidermal necrolysis (TEN). TEN can cause serious skin damage. Ask your provider for more information on TEN and other serious conditions.
  • Anaphylaxis symptoms include throat tightness, trouble breathing, tingling, dizziness, and wheezing. Anaphylaxis is a sudden, life-threatening reaction that needs immediate treatment. Anaphylaxis may occur if you exercise after exposure to a trigger, such as after you take an ARV medicine.

What increases my risk for an ARV medication allergy?

  • HIV or AIDS
  • A history of other infections, such as hepatitis B, hepatitis C, or Epstein-Barr virus (EBV)
  • A family history of ARV medicine reaction
  • A CD4 or CD8 cell (white blood cell) count above a certain level when you start the medicine
  • A CD4 cell count below a certain level when you start the medicine

How is an ARV medication allergy diagnosed?

Your healthcare provider will ask about your medical history and any allergies you have. You may need additional testing if you developed anaphylaxis after you were exposed to a trigger and then exercised. This is called exercise-induced anaphylaxis. You may also need any of the following:

  • Blood tests give healthcare providers information about how your body is working.
  • A patch test means your provider puts a small amount of the ARV medicine on your skin and covers the area with a patch. The patch stays on for 2 days. Then your provider checks your skin for a reaction.
  • Rechallenge may be used if the allergic reaction was mild. Your provider will have you take the medicine again. He or she will monitor you closely to see if you have another reaction.

How is an allergic reaction to an ARV medicine treated?

  • Steroids help reduce inflammation.
  • Antihistamines decrease mild symptoms such as itching or a rash.
  • Epinephrine is medicine used to treat severe allergic reactions such as anaphylaxis.
  • Desensitization is a controlled way to get your body used to the medicine. Your provider will start by giving you very small doses of ARV medicine over a few hours. Your provider will treat any allergic reaction that you have. The dose is increased a little at a time until the full dose is reached and the medicine stops causing an allergic reaction.

What steps do I need to take for signs or symptoms of anaphylaxis?

  • Immediately give 1 shot of epinephrine only into the outer thigh muscle.
  • Leave the shot in place as directed. Your provider may recommend you leave it in place for up to 10 seconds before you remove it. This helps make sure all of the epinephrine is delivered.
  • Call 911 and go to the emergency department, even if the shot improved symptoms. Do not drive yourself. Bring the used epinephrine shot with you.

What safety precautions do I need to take if I am at risk for anaphylaxis?

  • Keep 2 shots of epinephrine with you at all times. You may need a second shot, because epinephrine only works for about 20 minutes and symptoms may return. Your provider can show you and family members how to give the shot. Check the expiration date every month and replace it before it expires.
  • Create an action plan. Your provider can help you create a written plan that explains the allergy and an emergency plan to treat a reaction. The plan explains when to give a second epinephrine shot if symptoms return or do not improve after the first. Give copies of the action plan and emergency instructions to family members and work staff. Show them how to give a shot of epinephrine.
  • Be careful when you exercise. If you have had exercise-induced anaphylaxis, do not exercise right after you eat. Stop exercising right away if you start to develop any signs or symptoms of anaphylaxis. You may first feel tired, warm, or have itchy skin. Hives, swelling, and severe breathing problems may develop if you continue to exercise.
  • Carry medical alert identification. Wear medical alert jewelry or carry a card that explains your ARV medicine allergy. Ask your provider where to get these items.
  • Read medicine labels before you take any medicine. Do not take it if it contains the ARV medicine that you are allergic to. Ask a pharmacist if you are not sure.

Call 911 for signs or symptoms of anaphylaxis,

such as trouble breathing, swelling in your mouth or throat, or wheezing. You may also have itching, a rash, hives, or feel like you are going to faint.

When should I seek immediate care?

  • You feel warm and flushed.
  • You have a fast heartbeat.

When should I contact my healthcare provider?

  • You think you are having an allergic reaction. Contact your provider before you take another dose of your ARV medicine.
  • You have a fever.
  • You have a rash that is flat, red, and has small bumps.
  • You have a sore throat or swollen glands. You will feel hard lumps when you touch your throat if your glands are swollen.
  • You have muscle or joint pain and feel tired.
  • You have diarrhea, vomiting, or nausea.
  • You have questions or concerns about your ARV medicine.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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