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
...iagnosi...
...Consensus-based Statements...
...challenges
...that when the clinical probability of a drug al...
...hat placebo-controlled drug challenges be consid...
Testing for delayed hypersensitivity reacti...
...We suggest that for specific phenotypes of del...
...ta-lacta...
...mend that a proactive effort should be ma...
.... We recommend against any testing...
.... We suggest penicillin skin testing for pati...
...recommend against the routine use...
...d against penicillin skin testing p...
...uggest that direct amoxicillin challenge...
...suggest that for patients with a history of non-a...
...gest that for patients with a history...
...ggest that for patients with a histor...
...We suggest that for patients with a histor...
...ggest that in patients with a history...
...that in patients with a history of...
16. We suggest against penicillin...
...suggest that in patients with a history of penic...
...hat in patients with a history of pen...
...We recommend that allergist-immunologis...
Sulfonami...
...ggest that for patients with a history of benig...
...roquinolones and macrolides...
...1. We suggest using a 1- or 2-step drug challe...
...teroidal anti-inflammatory drug (NSAID) hypersens...
...t a selective cyclooxygenase (COX) -2 inhi...
...erbated respiratory disease (AERD)...
...ommend against an oral aspirin challenge to...
...We suggest an oral aspirin challenge to...
...t that a challenge procedure be used to d...
...NSAID-induced urticaria and angioedem...
...or patients with NSAID-induced urticaria and angi...
...hypersensitivity clinical scenarios...
27. We suggest a 2-step aspirin challenge f...
...herapeutic hypersensitivity...
.... We suggest that in patients with immedia...
...We suggest that patients with non-i...
Plati...
...hat for patients with a history of immed...
...that for patients with a history of immed...
...c hypersensitivity...
...e suggest that patients with non-immediate re...
...gest that for patients with immediate reactions...
...ipients allergy...
...the clinician recognize that excipients...
...ble 2. Testing Procedures for Delayed HSRsH...
.... Contraindications to Drug Challen...
...4. Open Drug Challenge Protocols for Imme...
...ble 5. Single-blind Placebo-controlled Challeng...
...Single-blind Placebo-controlled Challen...
.... Open Drug Challengee Protocols for Non-severe De...
...7. Testing Options for Delayed HSRsHaving t...
...HLA Associations With Delayed Drug HSRsHaving...
Figure 1. Timeline of Drug HSRs a Acute...
...Drugs With No or Weak Evidence of Cross-react...
...s of Beta-lactam Antibiotics that Share Side Ch...
...e 11. Immediate Hypersensitivity Cephalosporin...
...gure 4. Recommended Approach to Beta-lactam Admi...
...2. Criteria For 1- or 2-step TMP-SMX Oral...
...able 13. Classification of Common Aspirin/NSAID...
...1 and COX-2 Inhibiting MedicationsHaving t...
...al Characteristics Determining the...
.... Graded Aspirin Challenge Protocol fo...
...18. Various Commonly Utilized Aspirin Desen...
...9. NSAID Classification Based on Chemical Structur...
...20. Rapid Low Dose Aspirin Graded Challenge for Ca...
...nce and Characteristics of Chemotherapeu...