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Journal of Investigational Allergology... Jun 2022The clinical history is the cornerstone of the doctor´s work. When assessing patients consulting for a suspected hypersensitivity reaction to a drug, the details... (Review)
Review
The clinical history is the cornerstone of the doctor´s work. When assessing patients consulting for a suspected hypersensitivity reaction to a drug, the details collected in the patient´s clinical history are essential when deciding which tests to perform and for making recommendations about which drugs the patient should avoid and which can be taken. This area is especially important today, since many patients are labeled as allergic to drugs, especially penicillins, without this being the case. This article reviews the importance of the clinical history in a patient with a hypersensitivity reaction to a drug and considers which data should be collected. Likewise, a record-based model is proposed to help standardize the clinical history.
Topics: Drug Hypersensitivity; Humans; Penicillins; Skin Tests
PubMed: 35723206
DOI: 10.18176/jiaci.0819 -
Allergy Jul 2017This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the... (Review)
Review
Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology.
This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology, which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers are needed to allow their translation into practice in the clinical management of allergic disease.
Topics: Age of Onset; Allergens; Anaphylaxis; Biomarkers; Comorbidity; Drug Hypersensitivity; Food Hypersensitivity; Humans; Hypersensitivity; Phenotype; Precision Medicine; Severity of Illness Index
PubMed: 28122115
DOI: 10.1111/all.13132 -
Medicina (Kaunas, Lithuania) Apr 2022Hypersensitivity reactions to radiocontrast media seem to be rare in children. Furthermore, the use of radiocontrast media in children remains quite safe in terms of the... (Review)
Review
Hypersensitivity reactions to radiocontrast media seem to be rare in children. Furthermore, the use of radiocontrast media in children remains quite safe in terms of the severity of reactions. Since pediatric guidelines are lacking, the diagnostic workup employed in adults could be adapted to children, taking into account that results have not yet been validated in this age group. Specific protocols for risk stratification and management of severe reactions have been proposed so far.
Topics: Adult; Child; Contrast Media; Drug Hypersensitivity; Humans; Skin Tests
PubMed: 35454356
DOI: 10.3390/medicina58040517 -
Allergy Dec 2022Hypersensitivity reactions to drugs are increasing worldwide. They display a large degree of variability in the immunological mechanisms involved, which impacts both... (Review)
Review
Hypersensitivity reactions to drugs are increasing worldwide. They display a large degree of variability in the immunological mechanisms involved, which impacts both disease severity and the optimal diagnostic procedure. Therefore, drug hypersensitivity diagnosis relies on both in vitro and in vivo assessments, although most of the methods are not well standardized. Moreover, several biomarkers can be used as valuable parameters for precision medicine that provide information on the endotypes, diagnosis, prognosis, and prediction of drug hypersensitivity development, as well on the identification of therapeutic targets and treatment efficacy monitoring. Furthermore, in the last 2 years, the SARS-CoV-2 (severe acute respiratory syndrome-coronavirus) pandemic has had an important impact on health system, leading us to update approaches on how to manage hypersensitivity reactions to drugs used for its treatment and on COVID-19 (Coronavirus disease) vaccines used for its prevention. This article reviews recent advances in these 3 areas regarding drug hypersensitivity: in vitro tools for drug hypersensitivity diagnosis, recently identified biomarkers that could guide clinical decision making and management of hypersensitivity reactions to drugs and vaccines used for COVID-19.
Topics: Humans; Biomarkers; COVID-19; COVID-19 Vaccines; Drug Hypersensitivity; SARS-CoV-2; Vaccines
PubMed: 35912413
DOI: 10.1111/all.15461 -
Danish Medical Journal Aug 2023About 10% of hospital inpatients are labelled with penicillin allergy in their electronic medical record (EMR). However, allergy is confirmed in less than 10% of these...
INTRODUCTION
About 10% of hospital inpatients are labelled with penicillin allergy in their electronic medical record (EMR). However, allergy is confirmed in less than 10% of these records. Consequently, 90% of patients are treated with broad-spectrum antibiotics, contributing to antimicrobial resistance. We aimed to explore experiences and practices of healthcare professionals that may explain incorrect labelling of penicillin allergy in Denmark and elucidate any consequences hereof.
METHODS
An electronic survey was distributed to physicians and nurses in six hospital units in Copenhagen and via social media. The survey was active from 19 March to 1 May 2020. Data were assessed using descriptive statistics and by thematic analysis.
RESULTS
The response rate was 44.6%. The survey had 369 participants; 152 physicians and 217 nurses. Half of the physicians and one in every five nurses had experienced problems treating patients with a penicillin allergy label. Physicians reported limited trust in allergy labels, and labelling practices varied. The risk that patients may be truly allergic was the main reason for not removing labels (72%), and a precautionary principle was identified related to penicillin allergy labelling.
CONCLUSIONS
The penicillin allergy label is an independent factor of medication errors. Solutions to enhance patient safety may include education of physicians in allergy labelling, decision support, standardisation of the allergy registration in the various EMR systems used, and ideally also a national drug allergy register, which is accessible from all sectors.
FUNDING
None.
TRIAL REGISTRATION
Not relevant.
Topics: Humans; Drug Hypersensitivity; Hypersensitivity; Anti-Bacterial Agents; Attitude of Health Personnel; Penicillins
PubMed: 37622646
DOI: No ID Found -
Australian Family Physician 2013Adverse drug reactions (ADRs) vary from life-threatening anaphylaxis to minor common side-effects. (Review)
Review
BACKGROUND
Adverse drug reactions (ADRs) vary from life-threatening anaphylaxis to minor common side-effects.
OBJECTIVE
To provide an overview on the assessment of ADRs. To discuss the features of what may be described as a 'reaction to a drug' in order to highlight those suggestive of allergy, side-effect or intolerance, and what implications this might have for the future use or avoidance of the drug.
DISCUSSION
Assessment of an ADR may apply to a current reaction or a history of a past reaction. The main decision is whether to cease the drug and/or whether it can be used again. Some ADRs are serious and likely to be reproducible and constitute absolute contraindications, whereas others are mild and may or may not occur on subsequent exposure. The mechanism of the ADR may be helpful in risk assessment. Drug allergy has immunological mechanisms: it may be severe, tends to be reproducible and may cross-react with structurally related drugs. Drug side-effects are more common and predictable, vary in severity and depend on the drug's pharmacological action. Intolerance tends to be less severe, and may depend on susceptibility factors, which can vary. The decision to prescribe a drug where there is a history of a previous ADR requires careful assessment of the risks and potential benefits.
Topics: Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans
PubMed: 23529453
DOI: No ID Found -
Annals of Allergy, Asthma & Immunology... Jun 2020To review the relevant literature related to children with reported penicillin allergy and highlight the different ways in which children could be delabeled and to... (Review)
Review
OBJECTIVE
To review the relevant literature related to children with reported penicillin allergy and highlight the different ways in which children could be delabeled and to evaluate the public health impact that a penicillin allergy has for children.
DATA SOURCES
Data for this review were obtained via PubMed searches and then retrieval of articles from their respective journals for further review.
STUDY SELECTIONS
Studies regarding the safety of different ways to evaluate penicillin allergy in children were identified via PubMed searches. Any study that reported different ways of testing (3-tier, direct oral challenge, 5-day oral challenges) were included. This same format was used when selecting relevant articg:les related to the costs, prescription patterns, and stewardship trends associated with a penicillin allergy label.
RESULTS
This review found that penicillin allergy testing is a safe and effective way to delabel those with reported allergy. In children with low-risk allergy symptoms, a direct oral challenge approach may be optimal. In those children with a history of high-risk allergy symptoms, a 3-tiered approach is ideal. The review also found that there is a significant cost associated with reported penicillin allergy and that there are increased negative health benefits to those children with reported allergy.
CONCLUSION
Penicillin allergy is overdiagnosed, often incorrectly, and the label is frequently first applied during childhood. Targeting children for the removal of the incorrect penicillin allergy label provides a mechanism to reduce the use of broader-spectrum and less effective antibiotics.
Topics: Ambulatory Care; Anti-Bacterial Agents; Antimicrobial Stewardship; Child; Critical Pathways; Delivery of Health Care; Drug Hypersensitivity; Drug Utilization; Humans; Penicillins; Practice Patterns, Physicians'; Prevalence; Risk Management; Skin Tests
PubMed: 32224207
DOI: 10.1016/j.anai.2020.03.012 -
British Journal of Anaesthesia Dec 2021We sought to define the prevalence and nature of patient-reported drug allergies, determine their impact on prescribing, and explore drug allergy knowledge and attitudes... (Observational Study)
Observational Study
DALES, Drug Allergy Labels in Elective Surgical patients: a prospective, multicentre cross-sectional study of prevalence, nature and anaesthetists' approach to management.
BACKGROUND
We sought to define the prevalence and nature of patient-reported drug allergies, determine their impact on prescribing, and explore drug allergy knowledge and attitudes amongst anaesthetists.
METHODS
We performed a prospective cross-sectional study in 213 UK hospitals in 2018. Elective surgical patients were interviewed, with a detailed allergy history taken in those self-reporting drug allergy. Anaesthetists completed a questionnaire concerning perioperative drug allergy.
RESULTS
Of 21 219 patients included, 6214 (29.3 %) (95% confidence interval [CI]: 28.7-29.9) reported drug allergy. Antibiotics, NSAIDs, and opioids were the most frequently implicated agents. Of a total of 8755 reactions, 2462 (28.1%) (95% CI: 29.2-31.1) were categorised as high risk for representing genuine allergy after risk stratification. A history suggestive of chronic spontaneous urticaria significantly increased the risk of reporting drug allergy (odds ratio 2.68; 95% CI: 2.4-3; P<0.01). Of 4756 anaesthetists completing the questionnaire, 1473 (31%) (95% CI: 29.7-32.3) routinely discuss perioperative allergy risk with patients. Prescribing habits in the presence of drug allergy labels differ depending on the implicated agent. Most anaesthetists (4678/4697; 99.6%) (95% CI: 99.4-99.8) prescribe opioids when reactions are consistent with side-effects, although 2269/4697 (48%) (95% CI: 46.9-49.7) would avoid the specific opioid reported.
CONCLUSIONS
Almost 30% of UK elective surgical patients report a history of drug allergies, but the majority of reported reactions are likely to be non-allergic reactions. Allergy labels can impact on perioperative prescribing through avoidance of important drugs and use of less effective alternatives. We highlight important knowledge gaps about drug allergy amongst anaesthetists, and the need for improved education around allergy.
Topics: Adolescent; Adult; Aged; Anesthetists; Attitude of Health Personnel; Clinical Competence; Cross-Sectional Studies; Drug Hypersensitivity; Drug Labeling; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Practice Patterns, Physicians'; Prevalence; Prospective Studies; Surveys and Questionnaires; United Kingdom; Young Adult
PubMed: 34243942
DOI: 10.1016/j.bja.2021.05.026 -
Acta Bio-medica : Atenei Parmensis Jan 2019About 10% of the parents reported that their children are allergic to one drug and the betalactam antibiotics are the most frequently suspected. Even if most of the... (Review)
Review
About 10% of the parents reported that their children are allergic to one drug and the betalactam antibiotics are the most frequently suspected. Even if most of the adverse events following antibiotic prescriptions to children are considered allergic, after a full allergy work-up only a few of the suspected reactions are confirmed. For this reason, many children are incorrectly labelled as "allergic" and this represents an important challenge for the choice of the antibiotic therapy in these "labelled" children, who are frequently improperly deprived of narrow-spectrum antibiotics because considered as allergic. When an allergic reaction is suspected a precise diagnosis and a choice of a safe and effective alternative is essential for the future antibiotic option. In the light of this, the main aim of this paper is to try to provide a practical approach to managing the individuals who have reported adverse reactions to antibiotics.
Topics: Aminoglycosides; Anti-Bacterial Agents; Child; Drug Hypersensitivity; Glycopeptides; Humans; Macrolides; Quinolones
PubMed: 30830057
DOI: 10.23750/abm.v90i3-S.8157 -
International Archives of Allergy and... 2015Diagnosis of immediate drug hypersensitivity reactions (IDHRs) is based upon history taking, skin prick or intradermal tests and quantification of specific... (Review)
Review
BACKGROUND
Diagnosis of immediate drug hypersensitivity reactions (IDHRs) is based upon history taking, skin prick or intradermal tests and quantification of specific immunoglobulin E (IgE) antibodies. Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHRs and is impossible in the case of non-IgE-mediated IDHRs. Drug provocation tests (DPT) are considered the 'gold standard' diagnostic but are not always possible, for ethical and practical reasons. Therefore, the validation of new cellular tests such as basophil activation testing (BAT) was necessary. This review focuses on the applications of BAT in IDHRs.
METHODS
A literature search was conducted, using the words basophil, flow cytometry, immediate drug allergy and drugs; this was complemented by the authors' own expertise.
RESULTS
BAT/HistaFlow® is a useful diagnostic tool in IDHRs, mainly used to diagnose allergy to neuromuscular blocking agents (NMBAs), antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and iodinated radiocontrast media. Its sensitivity varies between 50 and 60%, and specificity attains 80%, except for with quinolones and NSAIDs.
CONCLUSIONS
The diagnostic utility of BAT (and to lesser extent HistaFlow) has been demonstrated and is mostly applied in IDHRs. However, larger-scale collaborative studies are necessary to optimize test protocols and validate the entry of BAT as a diagnostic instrument in drug allergy.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Basophils; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate
PubMed: 26524156
DOI: 10.1159/000440663