Drug allergy medical therapy: Difference between revisions
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==Management Strategies for Specific Drugs== | ==Management Strategies for Specific Drugs== | ||
* [[Penicillin]] - Treatment in penicillin allergic patients is best limited to non-penicillin agents. [[Carbapenems]] do not show a significant amount of [[cross-reactivity]] with penicillin, and may be administered as a graded challenge, after [[prophylactic]] skin testing with the chosen carbapenem. <ref name="pmid19193579">{{cite journal| author=Frumin J, Gallagher JC| title=Allergic cross-sensitivity between penicillin, carbapenem, and monobactam antibiotics: what are the chances? | journal=Ann Pharmacother | year= 2009 | volume= 43 | issue= 2 | pages= 304-15 | pmid=19193579 | doi=10.1345/aph.1L486 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19193579 }} </ref> Second or third generation [[cephalosporins]] may also be considered, as well as [[monobactams]] (unless the patient has had a prior reaction with [[ceftazidime]]). <ref name="pmid6537963">{{cite journal| author=Saxon A, Hassner A, Swabb EA, Wheeler B, Adkinson NF| title=Lack of cross-reactivity between aztreonam , a monobactam antibiotic, and penicillin in penicillin-allergic subjects. | journal=J Infect Dis | year= 1984 | volume= 149 | issue= 1 | pages= 16-22 | pmid=6537963 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6537963 }} </ref> Penicillin is the most common drug allergy, affecting up to 10 percent of patients. Ideal management of the patient with penicillin allergy should include penicillin skin testing, as up to 90% of patients will have negative [[skin test]] and will be able to recieve cephalosporins and other beta-lactam antibiotics safely. If penicillin is absolutely neccesary for treatment, [[desensitization]] should be considered and performed under medical supervision in a hospital. <ref name="pmid22165859">{{cite journal| author=Warrington R, Silviu-Dan F| title=Drug allergy. | journal=Allergy Asthma Clin Immunol | year= 2011 | volume= 7 Suppl 1 | issue= | pages= S10 | pmid=22165859 | doi=10.1186/1710-1492-7-S1-S10 | pmc=PMC3245433 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22165859 }} </ref> | * '''[[Penicillin]]''' - Treatment in penicillin allergic patients is best limited to non-penicillin agents. [[Carbapenems]] do not show a significant amount of [[cross-reactivity]] with penicillin, and may be administered as a graded challenge, after [[prophylactic]] skin testing with the chosen carbapenem. <ref name="pmid19193579">{{cite journal| author=Frumin J, Gallagher JC| title=Allergic cross-sensitivity between penicillin, carbapenem, and monobactam antibiotics: what are the chances? | journal=Ann Pharmacother | year= 2009 | volume= 43 | issue= 2 | pages= 304-15 | pmid=19193579 | doi=10.1345/aph.1L486 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19193579 }} </ref> Second or third generation [[cephalosporins]] may also be considered, as well as [[monobactams]] (unless the patient has had a prior reaction with [[ceftazidime]]). <ref name="pmid6537963">{{cite journal| author=Saxon A, Hassner A, Swabb EA, Wheeler B, Adkinson NF| title=Lack of cross-reactivity between aztreonam , a monobactam antibiotic, and penicillin in penicillin-allergic subjects. | journal=J Infect Dis | year= 1984 | volume= 149 | issue= 1 | pages= 16-22 | pmid=6537963 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6537963 }} </ref> Penicillin is the most common drug allergy, affecting up to 10 percent of patients. Ideal management of the patient with penicillin allergy should include penicillin skin testing, as up to 90% of patients will have negative [[skin test]] and will be able to recieve cephalosporins and other beta-lactam antibiotics safely. If penicillin is absolutely neccesary for treatment, [[desensitization]] should be considered and performed under medical supervision in a hospital. <ref name="pmid22165859">{{cite journal| author=Warrington R, Silviu-Dan F| title=Drug allergy. | journal=Allergy Asthma Clin Immunol | year= 2011 | volume= 7 Suppl 1 | issue= | pages= S10 | pmid=22165859 | doi=10.1186/1710-1492-7-S1-S10 | pmc=PMC3245433 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22165859 }} </ref> | ||
*[[Sulfonamides]] - Patients infected with [[HIV]] are at an increased risk of developing cutaneous reactions to sulfonamide antibiotics, however [[trimethoprim-sulfamethoxazole]] (TMP-SMX) remains to be the treatment of choice for many HIV associated infections. Induction of [[drug tolerance]] procedures can be used to safely administer sulfonamide drugs. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 20:47, 20 August 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]
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Overview
General Management Strategies
- Discontinuation of the allergen - The most effective strategy for treating or managing any type of allergy, is the immediate avoidance and discontinuation of the offending agent. When choosing drug therapy, alternative medications with unrelated chemical structures should be substituted for the chosen medication that has been known to cause allergy. Cross-reactivity of certain medications needs to be taken into account when selecting a treatment option. [1]
- Supportive/ symptomatic therapy - topical steroids and antihistamines are useful for cutaneous symptoms.
- Epinephrine - the treatment of choice in anaphylaxis is epinephrine, administered through intramuscular injection in the thigh.
- Corticosteroids - corticosteroids may be used systemically in severe reactions, but in the case of anaphylaxis it should be noted that epinephrine must be given, and it must be given before corticosteroids.
- Intensive care unit or burn unit - severe drug reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis are best treated in an intensive care unit or a burn unit setting, due to the special management required for such great amounts of insensible water loss from skin damage. [2]
Management Strategies for Specific Drugs
- Penicillin - Treatment in penicillin allergic patients is best limited to non-penicillin agents. Carbapenems do not show a significant amount of cross-reactivity with penicillin, and may be administered as a graded challenge, after prophylactic skin testing with the chosen carbapenem. [3] Second or third generation cephalosporins may also be considered, as well as monobactams (unless the patient has had a prior reaction with ceftazidime). [4] Penicillin is the most common drug allergy, affecting up to 10 percent of patients. Ideal management of the patient with penicillin allergy should include penicillin skin testing, as up to 90% of patients will have negative skin test and will be able to recieve cephalosporins and other beta-lactam antibiotics safely. If penicillin is absolutely neccesary for treatment, desensitization should be considered and performed under medical supervision in a hospital. [2]
- Sulfonamides - Patients infected with HIV are at an increased risk of developing cutaneous reactions to sulfonamide antibiotics, however trimethoprim-sulfamethoxazole (TMP-SMX) remains to be the treatment of choice for many HIV associated infections. Induction of drug tolerance procedures can be used to safely administer sulfonamide drugs.
References
- ↑ Khan DA, Solensky R (2010). "Drug allergy". J Allergy Clin Immunol. 125 (2 Suppl 2): S126–37. doi:10.1016/j.jaci.2009.10.028. PMID 20176256.
- ↑ 2.0 2.1 Warrington R, Silviu-Dan F (2011). "Drug allergy". Allergy Asthma Clin Immunol. 7 Suppl 1: S10. doi:10.1186/1710-1492-7-S1-S10. PMC 3245433. PMID 22165859.
- ↑ Frumin J, Gallagher JC (2009). "Allergic cross-sensitivity between penicillin, carbapenem, and monobactam antibiotics: what are the chances?". Ann Pharmacother. 43 (2): 304–15. doi:10.1345/aph.1L486. PMID 19193579.
- ↑ Saxon A, Hassner A, Swabb EA, Wheeler B, Adkinson NF (1984). "Lack of cross-reactivity between aztreonam , a monobactam antibiotic, and penicillin in penicillin-allergic subjects". J Infect Dis. 149 (1): 16–22. PMID 6537963.