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

Diagnosi...

 List of Consensus-based...

...g challenges...

...e suggest that when the clinical probability of a...

...t that placebo-controlled drug challenge...

...ng for delayed hypersensitivity reactions (HS...

...ggest that for specific phenotypes of de...

...-lactams...

...We recommend that a proactive effort sh...

...e recommend against any testing in patient...

6. We suggest penicillin skin testing for patients...

...We recommend against the routine use of mu...

...recommend against penicillin skin tes...

...hat direct amoxicillin challenge be consid...

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

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

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

...uggest that for patients with a history of an u...

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

...gest that in patients with a history of anaph...

...uggest against penicillin skin test...

...est that in patients with a history of penicillin...

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

...recommend that allergist-immunologists col...

...fonamides...

...that for patients with a history of ben...

...oquinolones and macrol...

...using a 1- or 2-step drug challenge witho...

...on-steroidal anti-inflammatory drug (NSA...

...We suggest a selective cyclooxygenase (C...

...in exacerbated respiratory disea...

...recommend against an oral aspirin chall...

...est an oral aspirin challenge to conf...

...st that a challenge procedure be used to diagnose...

...iple NSAID-induced urticaria and angioedema...

...ients with NSAID-induced urticaria and...

...n NSAID hypersensitivity clinical scenarios

...a 2-step aspirin challenge for patients with a h...

...ancer chemotherapeutic hypers...

28. We suggest that in patients with...

...e suggest that patients with non-immediate reacti...

Platin...

...t that for patients with a history of i...

...st that for patients with a history of i...

...iologic hypersensitivi...

...suggest that patients with non-imm...

...est that for patients with immediate rea...

...xcipients allerg...

...gest the clinician recognize that excipien...


...Procedures for Delayed HSRsHaving trouble v...


...Contraindications to Drug Challenges...


...4. Open Drug Challenge Protocols for Immediate Re...


...ble 5. Single-blind Placebo-controlled Challe...


...blind Placebo-controlled Challenge Protocols...


...le 6. Open Drug Challengee Protocols for Non-s...


...7. Testing Options for Delayed HSRsHav...


...HLA Associations With Delayed Drug HS...


.... Timeline of Drug HSRs a Acute generalized exanth...


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


...0. Groups of Beta-lactam Antibiotics tha...


...11. Immediate Hypersensitivity Cephalospo...


...mended Approach to Beta-lactam Admi...


...able 12. Criteria For 1- or 2-step TMP-SMX Oral C...


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


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


...nical Characteristics Determining the...


...aded Aspirin Challenge Protocol for...


...rious Commonly Utilized Aspirin Desensitizat...


...e 19. NSAID Classification Based on Chemic...


...Low Dose Aspirin Graded Challenge f...


...1. Incidence and Characteristics of Chemothe...