-
Revista Alergia Mexico (Tecamachalco,... 2022Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams....
Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams. Penicillin allergy ranks first in relation to drug allergy. 10 to 20 % of the population is labeled as allergic to it, often wrongly. Cross reaction is reported in 2 to 5 % between penicillins and cephalosporin. There is no cross reaction between penicillins and aztreonam, but there is with ceftazidime. All the mechanisms of the Gell and Coombs classification are included in the pathophysiology of hypersensitivity reactions to penicillin. Stratification according to risk allows us to take the most objective behavior to label the patient as allergic to. In the natural history of penicillin allergy, 80-90 % of patients lose this sensitivity by 10 years. If necessary, the patient can undergo a desensitization protocol. The immuno-allergist is a key piece in the selection of the patient, the elaboration of the challenge and desensitization protocols, in a controlled environment.
Topics: Anti-Bacterial Agents; Carbapenems; Cephalosporins; Cross Reactions; Drug Hypersensitivity; Humans; Penicillins; Skin Tests
PubMed: 34998313
DOI: 10.29262/ram.v69iSup1.1038 -
Immunology and Allergy Clinics of North... May 2022This review focuses on the current applications of telemedicine for drug hypersensitivity reactions. Telemedicine holds promise as a tool to risk-stratify patients with... (Review)
Review
This review focuses on the current applications of telemedicine for drug hypersensitivity reactions. Telemedicine holds promise as a tool to risk-stratify patients with drug hypersensitivity, for both evaluation of penicillin allergies and severe cutaneous adverse reactions. Although telemedicine may not fully replace in-person assessment owing to the need for testing, challenges, and in-person physical examination or skin biopsy, it may allow for risk stratification whereby some in-person visits may not be necessary. Electronic consults have also emerged along with telemedicine as a tool for drug allergy evaluations.
Topics: Drug Hypersensitivity; Humans; Physical Examination; Telemedicine
PubMed: 35469621
DOI: 10.1016/j.iac.2021.12.007 -
Clinical and Experimental Allergy :... Mar 2022
Topics: Anti-Allergic Agents; Drug Hypersensitivity; Humans
PubMed: 35194857
DOI: 10.1111/cea.14104 -
Allergologia Et Immunopathologia 2022Better knowledge and understanding about drug desensitization is required in the pediatric population, since there is little literature available about it and the most... (Review)
Review
Better knowledge and understanding about drug desensitization is required in the pediatric population, since there is little literature available about it and the most pediatric desensitization protocols have been adapted from adult instructions.Aiming to soften this issue and foster the future studies, this article presents a recent review about mechanisms of desensitization, diagnostic tools, and up to date management of drug hypersensitivity reactions in children. Bringing up an overview of pediatric hypersensitivity reactions to chemotherapy, biologic agents, antibiotics, nonsteroidal anti-inflammatory drugs, and vaccines.
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Child; Desensitization, Immunologic; Drug Hypersensitivity; Humans
PubMed: 35257545
DOI: 10.15586/aei.v50i2.539 -
Current Allergy and Asthma Reports Aug 2021Non-IgE-mediated drug reactions have traditionally been poorly defined and studied, though they are the most common form of hypersensitivity. Their presentations are... (Review)
Review
PURPOSE OF REVIEW
Non-IgE-mediated drug reactions have traditionally been poorly defined and studied, though they are the most common form of hypersensitivity. Their presentations are highly variable and can range in severity from mild, cutaneous-only reactions to severe systemic disease.
RECENT FINDINGS
The most notable advance in non-IgE-mediated hypersensitivity reactions is in diagnostics. HLA alleles have traditionally been used for identifying certain patients at risk for abacavir hypersensitivity syndrome, but more recent studies have shown several other HLA alleles associated with severe cutaneous adverse reactions with various medications. This article also highlights the use of delayed intradermal testing for radiocontrast media and patch testing for delayed antibiotic reactions. Drug reactions remain a major cause of morbidity and reason for treatment changes. Non-IgE-mediated reactions have had an increase in research interest over the past decade with an increased emphasis on better understanding the clinical presentation and underlying pathophysiology.
Topics: Drug Hypersensitivity; Humans; Skin; Stevens-Johnson Syndrome
PubMed: 34463914
DOI: 10.1007/s11882-021-01018-7 -
Handbook of Experimental Pharmacology 2022Allergy or hypersensitivity to drugs often affects the skin and sometimes also mucosa. While immediate type reactions show a rather homogeneous pattern, delayed type...
Allergy or hypersensitivity to drugs often affects the skin and sometimes also mucosa. While immediate type reactions show a rather homogeneous pattern, delayed type reactions reveal a high variability. In both cases it may not always be easy to differentiate drug reactions from non-drug-induced skin conditions. Furthermore, the different types of cutaneous adverse reactions may be difficult to distinguish in the beginning. This accounts predominately for delayed hypersensitivity reactions that can occur after a variety of medications and present with manifold lesions. Most of these cutaneous adverse reactions are mild, but some are severe with high morbidity and mortality. In the clinical setting, it is important to recognize the signs that point to a more severe condition early on in order to initiate appropriate management. In addition, it is crucial to identify the potentially culprit medication on the basis of a detailed medication history and by evaluating the relevant exposure times of certain drugs that differ substantially between the various reaction types. After the acute stage of the adverse reaction is managed successfully, further allergologic testing may be undertaken to confirm the offending drug.
Topics: Drug Hypersensitivity; Humans; Skin; Skin Tests
PubMed: 34219202
DOI: 10.1007/164_2021_490 -
Therapeutische Umschau. Revue... Jul 2019The diagnosis of drug allergy is essentially based on a detailed anamnesis, involving the doctors who first treated the patient, and skin testing (prick, intradermal and...
The diagnosis of drug allergy is essentially based on a detailed anamnesis, involving the doctors who first treated the patient, and skin testing (prick, intradermal and epicutaneous / patch tests). In the allergological practice / clinic, provocation tests with the presumed trigger are only carried out if the indication is very clear (see articles in this issue on drug allergy children, allergies to betalactam and other antibiotics as well as analgesic intolerance). The provocation with a probably tolerable alternative is in the foreground. Unfortunately, the skin tests of certain drug groups have a low sensitivity even under optimal conditions, but very good specificity. Accordingly, positive skin tests are mostly relevant, but negative skin tests cannot rule out an allergy. In recent years, it has therefore proved successful to carry out supplementary laboratory tests in the clarification of drug allergies. The serological tests (IgE) are of little help. In contrast, the test forms based on the analysis of leukocytes (basophil activation test, BAT, and lymphocyte transformation test, LTT) have gained in importance and complement the diagnostic repertoire. In the combination of all test methods (skin test, LTT, BAT, sometimes provocation test) the trigger of a drug allergy can be defined in a good 70 % of cases and in most cases a safe therapeutic alternative can be found. In the following, we will discuss the importance of laboratory diagnostics in drug allergy.
Topics: Anti-Bacterial Agents; Child; Drug Hypersensitivity; Humans; Lymphocyte Activation; Skin Tests; beta-Lactams
PubMed: 31282835
DOI: 10.1024/0040-5930/a001056 -
The Journal of Allergy and Clinical... Aug 2021
Topics: Drug Hypersensitivity; Humans
PubMed: 34366095
DOI: 10.1016/j.jaip.2021.04.009 -
The Journal of Allergy and Clinical... May 2024When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that...
When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that could be commonly referred to an allergist for assessment as "drug allergy," however, a real diagnosis exists that mandates a different diagnostic and treatment strategy, including a case of inducible laryngeal obstruction, multiple drug intolerance syndrome, viral rash, seizure due to metastatic malignancy, and hemophagocytic lymphohistiocytosis initially diagnosed as drug reaction and eosinophilia with systemic symptoms. The initial misdiagnoses of these patients delayed or interfered with their medical care, emphasizing the importance of accurate diagnoses for the benefit of our patients.
Topics: Humans; Diagnosis, Differential; Female; Male; Drug Hypersensitivity; Middle Aged; Lymphohistiocytosis, Hemophagocytic; Adult; Aged; Diagnostic Errors; Drug Hypersensitivity Syndrome
PubMed: 38325764
DOI: 10.1016/j.jaip.2024.01.047 -
Current Opinion in Allergy and Clinical... Aug 2020As drug allergy research aims to inform clinical practice, implementation of best practices may be influenced by financial resources required to incorporate new... (Review)
Review
PURPOSE OF REVIEW
As drug allergy research aims to inform clinical practice, implementation of best practices may be influenced by financial resources required to incorporate new interventions and the resulting clinical and economic returns on those resource investments. The present review summarizes new insights into the economics of drug allergy over the past year.
RECENT FINDINGS
While considering economic implications of recent drug allergy research, many studies have addressed different contextual factors related to the setting, provider, or outcomes. Advances in technology have enabled specialized allergists to support remote settings through telemedicine consultation. Training opportunities and interdisciplinary approaches to address drug allergy challenges have enabled multiple provider types to play a role in screening, diagnosis, and management. Penicillin allergy testing has been a major focus for many institutions, with several studies focused on de-labeling strategies including confirmatory skin testing and direct oral challenges.
SUMMARY
Studies over the past year provide new opportunities for the field of drug allergy research. The focus of current research to capture direct health costs or savings associated with drug allergy interventions demonstrates opportunity for more cost-effective care delivery and opportunity to explore greater benefits to society.
Topics: Allergists; Anti-Bacterial Agents; Cost Savings; Cost of Illness; Cost-Benefit Analysis; Drug Hypersensitivity; Health Care Costs; Health Plan Implementation; Humans; Penicillins; Practice Patterns, Physicians'; Skin Tests
PubMed: 32452890
DOI: 10.1097/ACI.0000000000000651