Drug Allergy
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
Diagnos...
...nsensus-based Statements...
...ug challenge...
...ggest that when the clinical probabili...
...t that placebo-controlled drug cha...
...layed hypersensitivity reactions (HSRs)...
...uggest that for specific phenotypes of delayed dr...
Beta-lactams
...recommend that a proactive effort should be made...
...recommend against any testing in patient...
...nicillin skin testing for patients with a hi...
...We recommend against the routine use of m...
...ecommend against penicillin skin testing prio...
...e suggest that direct amoxicillin challeng...
...that for patients with a history of non...
...that for patients with a history...
...2. We suggest that for patients with a history...
...hat for patients with a history of an unverified (...
14. We suggest that in patients with a history...
...uggest that in patients with a history...
...We suggest against penicillin skin test...
...t that in patients with a history of penicillin o...
...suggest that in patients with a his...
...commend that allergist-immunologists collabora...
...lfonamides...
...We suggest that for patients with a his...
...olones and macrolides...
...We suggest using a 1- or 2-step drug c...
...n-steroidal anti-inflammatory drug (NSAID) hypers...
...e suggest a selective cyclooxygenase (COX) -2 in...
...exacerbated respiratory disease (AERD)...
...recommend against an oral aspirin challe...
...We suggest an oral aspirin challenge to confirm t...
...t that a challenge procedure be used...
...induced urticaria and angioedema...
...ts with NSAID-induced urticaria and...
...AID hypersensitivity clinical scenarios...
...suggest a 2-step aspirin challenge for patient...
Cancer chemotherapeutic hypersensit...
...e suggest that in patients with immediate reac...
...ggest that patients with non-immediate react...
Platins
...t that for patients with a history of immediate a...
...gest that for patients with a history of i...
...ologic hypersensitivity
...t that patients with non-immediate reactions...
...est that for patients with immediate reactions...
...ipients allergy
...suggest the clinician recognize tha...
Table 2. Testing Procedures for Delayed HSRsH...
...Contraindications to Drug Challeng...
...e 4. Open Drug Challenge Protocols for Im...
...blind Placebo-controlled Challenge Proto...
...-blind Placebo-controlled Challenge Protocols -...
...ble 6. Open Drug Challengee Protocols for Non-sev...
...Testing Options for Delayed HSRsHaving...
...ociations With Delayed Drug HSRsHavin...
...gure 1. Timeline of Drug HSRs a Acute...
...With No or Weak Evidence of Cross-reactivity i...
...10. Groups of Beta-lactam Antibiotics that Share...
...11. Immediate Hypersensitivity Cephalosporin Sk...
...ommended Approach to Beta-lactam Adminis...
...Criteria For 1- or 2-step TMP-SMX Or...
...ssification of Common Aspirin/NSAID HSRsHaving tro...
...and COX-2 Inhibiting MedicationsHaving trouble...
...Clinical Characteristics Determin...
...ble 17. Graded Aspirin Challenge Protocol for Pati...
...us Commonly Utilized Aspirin Desensitizat...
...19. NSAID Classification Based on Chemical Str...
...20. Rapid Low Dose Aspirin Graded Cha...
...21. Incidence and Characteristics of Chem...