Drug allergy medical therapy: Difference between revisions
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* '''[[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. | * '''[[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. <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> | * '''[[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. <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> | ||
==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 }} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 20:27, 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. <ref name="pmid19193579">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.
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.
- ↑ 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.