How to Define and Manage Low-Risk Drug Allergy Labels
Details
Publication Year 2024-05,Volume 12,Issue #5,Page 1095-1106
Journal Title
Journal of Allergy and Clinical Immunology. In Practice
Publication Type
Review
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.
Publisher
Elsevier
Keywords
Humans; *Drug Hypersensitivity/diagnosis/therapy; Skin Tests; Risk Assessment; Penicillins/adverse effects/immunology; Immunoglobulin E; Anti-Bacterial Agents/adverse effects/immunology; Antibiotics; Chemotherapy; Clinical decision rule; Drug allergy; Iodinated contrast media; Low-risk; Nonsteroidal anti-inflammatory drugs
Department(s)
Infectious Diseases
Open Access at Publisher's Site
https://doi.org/10.1016/j.jaip.2024.03.021
Terms of Use/Rights Notice
Refer to copyright notice on published article.


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