Diagnosing and managing drug allergy

Abrams, Elissa M.; Khan, David A.

doi:10.1503/cmaj.171315

Cited by 16 publications

(7 citation statements)

References 46 publications

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“…However, there was a high proportion of inconclusive reactions that could not be exactly determined due to insufficient information or other reasons as mentioned. Some of them may not be the problem if they were systematically investigated, completely documented, and judiciously considered by experienced healthcare professionals at the time of adverse reaction occurrence, since all necessary data could possibly be completed [ 25 ]. Measures to improve patients’ knowledge and understanding of drug allergy such as comprehensive counseling with printed information personalized for patients' health literacy levels and a validated drug allergy personal card should also be effectively provided [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary approach to verify and de-label of drug allergic histories in a university hospital in Thailand: a retrospective descriptive study

Palapinyo

Klaewsongkram

Mongkolpathumrat

et al. 2023

J of Pharm Policy and Pract

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Background Mislabeling of drug allergic histories causes avoidable negative impacts on patients and healthcare system. Although multidisciplinary adverse drug reaction (ADR) services to verify and de-label drug allergic histories have been operated in particular hospitals in Thailand, their performances have not been reported. This research aimed to examine the effectiveness of verification of drug allergic history and de-labeling (VD) services of the physician-led multidisciplinary ADR clinic. Methods This research was a retrospective descriptive study. Medical charts of patients with at least one drug allergic history who received VD services at the multidisciplinary clinic between January 2017 to December 2018, were reviewed. Data on the history of drug allergy, VD services, and results were analyzed and presented using descriptive statistics. Results Seventy patients’ charts were reviewed, and 171 unconfirmed drug allergic histories were identified. 79.53% of the reported reactions involved skin and soft tissues. The most found adverse skin reactions were maculopapular rash, pruritic and erythematous rash, and angioedema. The remaining 20.47% were systemic reactions which included drug reaction with eosinophilia and systemic symptoms (DRESS), anaphylaxis, and nausea/vomiting was the most prevalent. Antituberculosis, beta-lactam antibiotics, and nonsteroidal anti-inflammatory drugs (NSAIDs) were the most reported suspected drugs. Drug allergic history reviewing by physicians or pharmacists could confirm and de-label for 3 and 20 reactions, respectively. Seven and one reactions were confirmed by enzyme‐linked immunospot assay and patch test, respectively. The provocation tests with the suspected or alternative drug were conducted in 64 reactions. Twelve reactions were confirmed, and 45 reactions were de-labeled. Totally, 65/171 (38.01%) allergic histories were successfully de-labeled, 23/171 (13.45%) were confirmed, and 83/171 (48.53%) were inconclusive. Conclusions More than half of drug allergic histories were successfully confirmed or de-labeled by the multidisciplinary ADR team. The collaborative activities of various healthcare professionals, consisting of physicians, nurse, and pharmacists as presented in the study were effective in VD services and should be implemented in other healthcare settings.

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Section: Discussionmentioning

confidence: 99%

A multidisciplinary approach to verify and de-label of drug allergic histories in a university hospital in Thailand: a retrospective descriptive study

Palapinyo

Klaewsongkram

Mongkolpathumrat

et al. 2023

J of Pharm Policy and Pract

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“…"Diagnosis of drug allergy is largely based on clinical history because diagnostic tests are limited. Most patients who are labelled as having penicillin allergy can tolerate penicillins after allergy evaluation" (20). Many patients report being allergic to peni cillin, but only very few of them have clini cally significant reactions (21).…”

Section: Discussionmentioning

confidence: 99%

Self-reported allergy to parenterally administered penicillin

Ljubisavljević¹,

Živanović²

2020

ABC - čas urg medicine

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Introduction: Penicillin and penicillin products are in use in everyday medical practice. The most frequently reported adverse drug reactions are those to penicillin. New penicillin allergies occur more often with parenteral than oral treatment. In patients who are allergic to penicillin, prescribed therapy is more often the one of antibiotics of broad spectrum, and this therapy is more expensive. The allergies to penicillin are immunologically mediated. Scope of Study: to present patients' self-reported allergy to penicillin and report on types of adverse reactions following the parenteral administration of penicillin. Methodology: Retrospective study of the work of one physician in the City Institute for EMS Belgrade in the period from 2017 to 2018 involving 2481 patients. Results: There were 242 patients who reported they were allergic to penicillin, of which 160 were able to explain what happened after they were given parenteral penicillin. The cohort group was between 18-85 years old, average age 49.64 ± 17.24, while 65% of them were females. Most frequently reported adverse reactions were rash, redness and itching of the skin, loss of consciousness, swelling of the face, mouth, arms or body in general. Serious reactions have been reported in about 40% of cases. Conclusion: There is a large percentage of self-reported allergies to penicillin, and only a small number of those who experienced serious adverse reactions: swelling, unconsciousness, coma or shock.

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“…It's may be the most fixed in vivo test to confirm the existence of an antibiotic allergy. [10][11][12] The therapeutic dose was reached with no reaction, so it was concluded no allergic reaction to Ceftriaxone, she could take the drug as prescribed for 5 days.…”

Section: Progress Notementioning

confidence: 97%

Cephalosporin graded challenges approach in community–acquired pneumonia patient with a history of penicillin allergy

Suryana¹

2021

Int J Res Med Sci

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Community-Acquired Pneumonia (CAP) is an acute pulmonary parenchyma infection that acquired in the community. Diagnosis based on clinical manifestations, chest X-ray (CXR) and microbiological diagnosis test (lung aspirates culture). Recently there was advance in antimicrobial treatments of CAP and a microbiological diagnostic test is essential to ensure antimicrobial treatments. In the other hand microbiological diagnostic test does not achieve all of the pneumonic cases. Therefore, antimicrobial treatment should be empirically performed to avoid the delay in establishing appropriate treatment related with the mortality. By administering combination antimicrobial will achieve a better outcome than a mono-therapy. For patients with history of penicillin allergy, though the risk of cephalosporin allergic cross-reactivity is low, a greater awareness is still needed, so a graded challenge approach could be considered. Herein we present a case report of a female, 20-year-old, hospitalized due to CAP, and also had a history of penicillin allergy. She was treated by levofloxacin 750 mg IV q 24 hour and cephalosporin (ceftriaxone) 1 g IV q 12 hour with a Graded challenge approach. Although it does not a novelty, we hope it would remind the health care that a Graded challenge could be considered as an approach of administering cephalosporin in patient who has an experiece of penicillin allergy.

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Diagnosing and managing drug allergy

Cited by 16 publications

References 46 publications

A multidisciplinary approach to verify and de-label of drug allergic histories in a university hospital in Thailand: a retrospective descriptive study

A multidisciplinary approach to verify and de-label of drug allergic histories in a university hospital in Thailand: a retrospective descriptive study

Self-reported allergy to parenterally administered penicillin

Cephalosporin graded challenges approach in community–acquired pneumonia patient with a history of penicillin allergy

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