How to Define and Manage Low-Risk Drug Allergy Labels.

J Allergy Clin Immunol Pract

Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia; Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia.

Published: May 2024

AI Article Synopsis

  • Risk stratification in drug allergy categorizes reactions into low, moderate, and high risk based on various factors like reaction timing, management needs, and individual patient characteristics.
  • Despite numerous frameworks for assessing drug allergies, especially for penicillin, there is no global consensus, leading to differing methods across allergy centers.
  • The review highlights low-risk drug allergies related to certain antibiotics and chemotherapeutics, advocating for risk-based approaches in diagnosis and management, including the use of direct oral challenges for low-risk individuals.

Article Abstract

Risk stratification in drug allergy implies that specific risk categories (eg, low, moderate, and high) classify historical drug hypersensitivity reactions. These risk categories can be based on reaction phenotypic characteristics, the timing of the reaction and evaluation, the required reaction management, and individual characteristics. Although a multitude of frameworks have been described in the literature, particularly for penicillin allergy labels, there has yet to be a global consensus, and approaches continue to vary between allergy centers. Immune-mediated drug allergies can sometimes be confirmed using skin testing, but a negative drug challenge is required to demonstrate tolerance and remove the allergy from the electronic health record ("delabel" the allergy). Even for quintessential IgE-mediated drug allergy, penicillin allergy, recent data reveal that a direct oral challenge, without prior skin testing, is an appropriate diagnostic strategy in those who are considered low-risk. Drug allergy pathogenesis and clinical manifestations may vary depending on the culprit drug, and as such, the optimal approach should be based on risk stratification that considers individual patient and reaction characteristics, the likely hypersensitivity reaction phenotype, the drug class, and the patient's clinical needs. This article will describe low-risk drug allergy labels, focusing on β-lactam and sulfonamide antibiotics, nonsteroidal anti-inflammatory drugs, iodinated contrast media, and common chemotherapeutics. This review will also address practical management approaches using currently available risk stratification and clinical decision tools.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493333PMC
http://dx.doi.org/10.1016/j.jaip.2024.03.021DOI Listing

Publication Analysis

Top Keywords

drug allergy
20
low-risk drug
12
allergy labels
12
risk stratification
12
drug
10
allergy
10
risk categories
8
penicillin allergy
8
skin testing
8
risk
5

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!