Cross reactivity definition drug allergy1/13/2024 ![]() ![]() ![]() Despite these threats, the histories associated with documentedĪllergies are rarely reconciled, or acted on, by the health care team. Inaccurately determined allergies might result in the use of unnecessarily broad-spectrum or inferiorĪntibiotics, posing a threat to patient safety and public health. Of penicillin allergy, this Review provides a global update on antibiotic allergy epidemiology, classification, mechanisms, andĪntibiotics can result in adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) through a variety of mechanisms.Īntibiotic allergies are frequently documented in the electronic health record, which results in changes to the care of future Penicillins are not allergic when appropriately stratified for risk, tested, and re-challenged. A penicillin allergy label, in particular, is associated with increased use of broad-spectrum and non-β-lactamĪntibiotics, which results in increased adverse events and antibiotic resistance. Antibiotic allergy labels result in displacement of first-line therapies for antibiotic prophylaxis and Although such reactions pose negligible risk to patients, they currently represent a global However, many antibiotic reactions documented asĪllergies were unknown or not remembered by the patient, cutaneous reactions unrelated to drug hypersensitivity, drug-infection Including anaphylaxis, and organ-specific and severe cutaneous adverse reactions. Referals to other providers when appropriate (e.g.Antibiotics are the commonest cause of life-threatening immune-mediated drug reactions that are considered off-target, Patient education (e.g., recognition of likely allergenic medication, risk of cross-reactivity with related agents, use of epinephrine self-injectors if applicable) Management of the condition for which the allergic medication was indicated (e.g., treatment of the underlying infection for which the allergenic antibiotic was indicated) Management of the allergic reaction (see Table e-88-3 if patient presents with anaphylaxis) Need for drug desensitization or induction of drug tolerance (see Tabe e-88-5) Medications that may interfere with the identification or treatment of the allergic reaction (e.g., chronic use of antihistamines when skin testing may be warranted chronic beta-blocker use in a patient with anaphylaxis) Severity of the reaction (e.g., localized rash versus a systemic reaction involving one or more organs) Presence of risk factors (see section on Factors related to the Risk or Severity of Allergic Drug Reactions)Ĭo-administration of medications that may increase the risk of an allergic reaction when used in combination (e.g., lamotrigine and valproate) Likelihood of cross-reactivity relative to documented allergy history (e.g., previous documented allergy to penicillin in a patient currently receiving a beta-lactam antibiotic) Timing of the reaction relative to the initiation of each of the patient's current medications Observation of the rash, if applicable (e.g., type of lesion(s), distribution of lesions, presence or absence of oral or genital ulcerations, presence or absence of bullae) Labs (e.g., serum electrolytes, Scr, BUN, LFTs) Subjective findings of the allergic reaction (e.g., shortness of breath, itching, feeling of flushing, lip tingling, nausea, lightheadedness) Medication history (e.g., prescription, OTC, and complementary medications such as herbals)Īllergy history (e.g., medications, foods, environmental exposures with descriptions of each reaction) Patient characteristics (e.g., age, race, sex, pregnant) Patient Care Process for the Management of Drug Allergy ![]()
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