BSACI guidelines for the management of drug allergy

Mirakian, Rita; Ewan, P. W.; Durham, Stephen R.; Youlten, L. J. F.; Dugué, Pierre Antoine; Friedmann, Peter S.; English, John; Huber, P.; Nasser, Shuaib

doi:10.1111/j.1365-2222.2008.03155.x

Cited by 213 publications

(232 citation statements)

References 152 publications

(177 reference statements)

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“…As already highlighted by the BSACI drug allergy Guideline [97], a detailed and accurate clinical history is required as the first step to a correct diagnosis. This should include details of the drug, the nature, the time of onset and resolution of the symptoms.…”

Section: Diagnosismentioning

confidence: 99%

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Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Diagnosismentioning

confidence: 99%

“…The procedure for skin testing follows the general principles laid out in the BSACI drug allergy guidelines [97]. Histamine as a positive control and relevant negative controls (usually the diluent) must be included.…”

Section: Safety Of Skin Testsmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

Self Cite

228

229

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show abstract

“…The risk of immediate reactions to drugs is higher in young and middle aged adults, in individuals carrying genetic polymorphisms of human leukocytes antigens and drug metabolism pathways; and in those infected by human immunodeficiency virus (HIV) and Epstein Barr Virus (EBV) [63]. Repeated administration of the drug increases the risk of allergic reaction [64].…”

Section: Prevention Of Infusional Reactions and Rechallengingmentioning

confidence: 99%

Immediate Reactions To Monoclonal Antibodies In Clinical Hematology

Kyriazi

2016

IJMS

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Monoclonal antibodies (MoAbs) have been widely used in clinical hematology. As foreign macro-molecules, they can cause infusional reactions during the administration or within 24 hours after the infusion, which encompass a spectrum of mechanisms. Although most of these reactions are non-allergic, are often indistinguishable from true allergic reactions mediated by IgE immunoglobulins. The diagnosis is often challenging and relies mainly on clinical criteria. They occur during the first doses, soon after the initiation of treatment. The symptoms are usually well controlled by the immediate drug discontinuation or reduction of the infusion rate. The management remains largely supportive, consisting of oxygen, intravenous fluids, bronchodilators, antihistamines and steroids. Most of MoAb protocols recommend premedication with steroids and antihistamines and gradually escalating infusion rates. Increased medical and nursing vigilance is required and resuscitative equipment should always be readily available. These events affect patients' quality of life, leading to treatment delay or discontinuation and series of tests. The decision to rechallenge the treatment depends on severity grading, clinical parameters and treatment goals. This article provides an update of MoAbs used in clinical hematology. It summarizes the pathophysiology, the diagnostic approach, the preventive measures and treatment of MoAb-related reactions.

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“…It has been defined by the British Society for Allergy and Clinical Immunology (BSACI) as 'an ADR with an established immunological mechanism'. 2,3 The subject of drug allergy is very topical, particularly with the focus on patient safety, and has attracted the attention of the National Institute for Health and Care Excellence (NICE) with publication of clinical guidelines on drug allergy in 2014 and quality standards in 2015. 3,4 The intention of this article is not to provide a comprehensive review of drug allergy, but rather to introduce the topic and highlight indications for referral to specialists for management of drug allergy.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it is only carried out with specific indications and by specialist allergy services with full monitoring and resuscitation facilities available. 2 Testing can involve the index drug, or drug alternatives. It is considered only after all other investigations (if validated) have been completed, if the diagnosis is still doubtful and management would be affected by conducting the drug challenge.…”

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confidence: 99%

Introduction to drug allergy, and whom to refer for specialist assessment?

Kasternow

Karim

2016

Clinical Medicine

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Drug allergy is defined as an adverse drug reaction with an established immunological mechanism. The National Institute for Health and Care Excellence published clinical guidelines on drug allergy in 2014 and quality standards in 2015. The intention of this article is to highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical of course for patient safety, but also for better use of the drugs that we have available and to reduce unnecessary avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. It is, therefore, important to highlight to general physicians and physicians of other specialties, those patients who do require referral for specialist review. IntroductionAn adverse drug reaction (ADR) is defined as 'an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product '.1 However, drug allergy has a more specific definition. It has been defined by the British Society for Allergy and Clinical Immunology (BSACI) as 'an ADR with an established immunological mechanism'.2,3 The subject of drug allergy is very topical, particularly with the focus on patient safety, and has attracted the attention of the National Institute for Health and Care Excellence (NICE) with publication of clinical guidelines on drug allergy in 2014 and quality standards in 2015.3,4 The intention of this article is not to provide a comprehensive review of drug allergy, but rather to introduce the topic and highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical for patient safety, for better use of the drugs that we have available and to reduce the unnecessary ABSTRACT Introduction to drug allergy, and whom to refer for specialist assessment?avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. AssessmentThere is an issue of perception versus reality with respect to drug allergy. The prevalence of drug allergy estimated by patients in the general population is much higher than can be found objectively. For example, there are significant differences in the perception of the frequency of penicillin allergy. 5 This raises an important point in the initial evaluation of the patient with suspected drug allergy. In most cases, clinical ...

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BSACI guidelines for the management of drug allergy

Cited by 213 publications

References 152 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Immediate Reactions To Monoclonal Antibodies In Clinical Hematology

Introduction to drug allergy, and whom to refer for specialist assessment?

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