Penicillin Allergy and Desensitization in Serious Infections during Pregnancy

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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“…Many protocols have been published since [210][211][212][213][214]. An example is given in Appendix Table A3.…”

Section: Desensitizationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

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“…However, no fatal reactions have been reported so far. Desensitisations have been performed safely in pregnant women [35]. Table 3 for an example of desensitization for amoxicillin.…”

Section: Desensitizationmentioning

confidence: 99%

Antibiotic Allergy, When to Test, Challenge or Desensitise

Nasr¹,

Wahshi²,

Wahshi³

et al. 2016

J Med Microb Diagn

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Antibiotics are widely used for treatment of bacterial infections and for prophylaxis during instrumental procedures and in certain conditions such as immunodeficiency and splenectomy.Hypersensitivity (allergic) reactions are unpredictable and can occur in some patients even if they have taken the antibiotic in the past with no reaction. Drug allergy accounts for 11.3% of all adverse drug reactions. Drug allergy drugs can be generally classified (according to the World Allergy Organization) based on timing of symptoms into immediate (Immunoglobulin E (IgE) mediated) occurring within 1 hour and delayed (non IgE mediated) allergic reactions occurring after 1 hour. Many patients are mislabeled with drug allergy especially when the diagnosis is made based on history alone. In such cases, a referral to an allergist is important to confirm or exclude allergy through a detailed clinical history, in vitro and/or in vivo testing, as over diagnosis of drug allergy leads to the unnecessary use of broader spectrum and expensive antibiotics contributing to the emergence of multidrug resistant pathogens. Also, in cases of confirmed drug allergy it is important to establish potential cross reactivity with other drugs. Equally, patients with confirmed drug allergy, who have an absolute requirement for the drug or cross reactive drug (as in penicillin allergic females with syphilis) can undergo a process of desensitization in order to complete their treatment through induction of temporary tolerance of the drug.

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“…This is a straightforward, relatively safe procedure that can be performed orally or intravenously. Modified protocols may be considered based on an individual's symptoms, drug of choice, and route of administration [457][458][459] . Although the two approaches have not been compared, oral desensitization is regarded as safer and easier to perform.…”

Section: Desensitizationmentioning

confidence: 99%

1989 Sexually Transmitted Diseases Treatment Guidelines

&NA;

1990

The Pediatric Infectious Disease Journal

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This information is distributed solely for the purpose of pre-dissemination peer review under applicable information quality guidelines. It has not been formally disseminated by the Centers for Disease Control and Prevention. It does not represent and should not be construed to represent any agency determination or policy. Guidelines, 2010 (MMWR 201059 [No. RR-12] Contents IntroductionThe term sexually transmitted diseases (STDs)is used to refer to a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity. Physicians and other health-care providers play a critical role in preventing and treating STDs. These guidelines for the treatment of STDs are intended to assist with that effort. Although these guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.This document updates the CDC Sexually Transmitted Diseases Treatment Guidelines published in 2010 1 .These recommendations should be regarded as a source of clinical guidance and not prescriptive standards. Health-care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. These guidelines are applicable to any patient-care setting that serves individuals at risk for STDs, including familyplanning clinics, HIV-care clinics, private physicians' offices, Federally Qualified Health Centers, and other primary-care facilities. These guidelines focus on the treatment and counseling of individuals and do not address other community services and interventions that are essential to STD/human immunodeficiency virus (HIV) prevention efforts. MethodsThese guidelines were developed by CDC staff and an independent workgroup selected on the basis of their expertise in the field of STDs. Members of the multidisciplinary workgroup included representation from federal, state, and local health departments, clinical and basic science researchers, and numerous professional organizations. (listed at the end of this document). All workgroup members provided conflict of interest form and several members of the workgroup acknowledged receiving financial support from companies performing clinical research All potential conflicts of interest were disclosed and managed in accordance with the editorial standards of the journals that published the scientific reports.Specifically in 2012, CDC staff and workgroup members were asked to identify key questions regarding STD treatment and clinical management that emerged since the 2010 STD Treatment Guidelines.Development of these key questions focused on four principal outcomes of STD therapy for each individual disease or infection: 1) treatment of infection based on microbiologic eradication; 2) alleviation of signs and symptoms; 3) prevention of sequelae; and 4) prevention of transmission, 5) cost-effectiveness and other advantages and disadvantages of specific regimens. Then, CDC staff members assigned workgroup members key questions to research, and with the ...

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Penicillin Allergy and Desensitization in Serious Infections during Pregnancy

Cited by 245 publications

References 18 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Antibiotic Allergy, When to Test, Challenge or Desensitise

1989 Sexually Transmitted Diseases Treatment Guidelines

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