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
...gnosis
...ist of Consensus-based Statem...
...challenges...
...uggest that when the clinical probability of...
...uggest that placebo-controlled drug challeng...
...elayed hypersensitivity reactions (HSRs)...
...suggest that for specific phenotypes of delayed dr...
...ta-lactams...
...We recommend that a proactive effor...
5. We recommend against any testing in...
6. We suggest penicillin skin testi...
...against the routine use of multiple day chall...
...against penicillin skin testing prior to direct...
...suggest that direct amoxicillin cha...
...t that for patients with a history of non-...
...We suggest that for patients with a hi...
...that for patients with a history of anaphylaxis...
...that for patients with a history of an...
...e suggest that in patients with a history...
...est that in patients with a history of...
...against penicillin skin testing in pati...
...suggest that in patients with a history...
.... We suggest that in patients with a...
...e recommend that allergist-immunologists col...
Sulfonam...
...hat for patients with a history of benign...
...uinolones and macrolides...
...We suggest using a 1- or 2-step drug c...
Aspirin/non-steroidal anti-inflammato...
.... We suggest a selective cyclooxygenase (...
...bated respiratory disease (AERD)...
...e recommend against an oral aspirin...
...an oral aspirin challenge to confirm the diagno...
...hat a challenge procedure be used t...
...ID-induced urticaria and angioedema
...For patients with NSAID-induced urtica...
...hypersensitivity clinical scenarios...
...suggest a 2-step aspirin challenge for pat...
...chemotherapeutic hypersensitivity...
...hat in patients with immediate reactions to chem...
...hat patients with non-immediate re...
...latin...
...suggest that for patients with a history of im...
...We suggest that for patients with a...
...hypersensitivity...
...that patients with non-immediate reaction...
...st that for patients with immediate reactions...
...xcipients alle...
...suggest the clinician recognize that ex...
...le 2. Testing Procedures for Delayed HSRsHavi...
...ntraindications to Drug ChallengesHaving...
...le 4. Open Drug Challenge Protocols for Imme...
...-blind Placebo-controlled Challenge P...
...Single-blind Placebo-controlled Challeng...
...en Drug Challengee Protocols for Non-severe...
...ng Options for Delayed HSRsHaving t...
...8. HLA Associations With Delayed Drug HSRsHa...
...igure 1. Timeline of Drug HSRs a Acute generaliz...
...ugs With No or Weak Evidence of Cr...
...ble 10. Groups of Beta-lactam Antibiotics that Sh...
...iate Hypersensitivity Cephalosporin...
...Recommended Approach to Beta-lactam Admini...
...able 12. Criteria For 1- or 2-step TMP-SMX...
...3. Classification of Common Aspirin/NSAID...
...able 15. COX-1 and COX-2 Inhibiting MedicationsHa...
...Clinical Characteristics Determini...
...able 17. Graded Aspirin Challenge Protocol...
...18. Various Commonly Utilized Aspirin Dese...
...ID Classification Based on Chemical Stru...
...Low Dose Aspirin Graded Challenge for Card...
...21. Incidence and Characteristics...