Drug Allergy

Publication Date: October 3, 2022

Key Points

Key Points

  • Significant new information and recommendations update the 2010 drug allergy practice parameter.
  • There is an overall de-emphasis on the use of skin testing as compared with drug challenge.
  • More emphasis is placed on risk stratification based on reaction phenotype.
  • When clinical probability of drug allergy is low, 1- or 2-step drug challenges are the preferred evaluation.
  • For patients with reported penicillin allergy, proactive efforts should be made to delabel and also avoid unnecessary avoidance of non-cross reactive antibiotics.
  • Consideration of phenotypes for adverse reactions to various non-antibiotic drugs (NSAIDs, biologics) should be used to guide evaluation and management.

Diagnosis

...agnosis

...List of Consensus-based S...

...challenges...

...suggest that when the clinical probab...

...We suggest that placebo-controlled drug challen...

...or delayed hypersensitivity reactions (HSRs)...

...at for specific phenotypes of delayed drug...

...eta-lacta...

...mmend that a proactive effort should be made to...

.... We recommend against any testing i...

...st penicillin skin testing for patients with a his...

...recommend against the routine use of mul...

...ommend against penicillin skin testing prior to di...

...suggest that direct amoxicillin challenge be...

...e suggest that for patients with a h...

...that for patients with a history o...

...hat for patients with a history of anaphyla...

...st that for patients with a history of an unverifi...

...est that in patients with a history of an unverif...

...hat in patients with a history of anaphylax...

...against penicillin skin testing in p...

.... We suggest that in patients with a history o...

...suggest that in patients with a history of...

19. We recommend that allergist-im...

...lfonamides...

...that for patients with a history of benign cutane...

...roquinolones and macrolides

21. We suggest using a 1- or 2-step d...

...n-steroidal anti-inflammatory drug (NSAI...

...gest a selective cyclooxygenase (COX) -2...

...n exacerbated respiratory disease (AERD)...

...against an oral aspirin challenge to con...

...an oral aspirin challenge to confirm the...

...e suggest that a challenge procedure be...

...SAID-induced urticaria and angioedema...

...or patients with NSAID-induced urticaria and angi...

...NSAID hypersensitivity clinical scen...

...a 2-step aspirin challenge for pati...

...herapeutic hypersensitivity...

...We suggest that in patients with immediat...

...We suggest that patients with non-immediat...

Plati...

...est that for patients with a history of immediate...

...e suggest that for patients with a history of...

...c hypersensitivity...

32. We suggest that patients with non...

...that for patients with immediate reactions...

...ients allergy...

...he clinician recognize that excipien...


...able 2. Testing Procedures for Dela...


...Contraindications to Drug ChallengesHaving t...


...4. Open Drug Challenge Protocols f...


...5. Single-blind Placebo-controlled...


...Single-blind Placebo-controlled Challenge Proto...


...Drug Challengee Protocols for Non-se...


...le 7. Testing Options for Delayed HSRsHaving t...


...e 8. HLA Associations With Delayed Drug...


Figure 1. Timeline of Drug HSRs a A...


...e 9. Drugs With No or Weak Evidence...


...roups of Beta-lactam Antibiotics th...


...ble 11. Immediate Hypersensitivity Cephal...


...ommended Approach to Beta-lactam Administr...


...iteria For 1- or 2-step TMP-SMX Oral Cha...


...le 13. Classification of Common Aspirin/N...


...15. COX-1 and COX-2 Inhibiting Medi...


...16. Clinical Characteristics Determining the...


...ble 17. Graded Aspirin Challenge Prot...


...arious Commonly Utilized Aspirin Desens...


...able 19. NSAID Classification Based on...


...Rapid Low Dose Aspirin Graded Challenge for Car...


...dence and Characteristics of Chemotherapeu...