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Drug Allergy & Cross-Reactivity

Welcome to the drug allergy and cross-reactivity category for physicians and pharmacists. This category features links to clinical practice resources on managing drug allergies and cross-reactivity reactions to drugs such as penicillins, cephalosporins, sulfonamides, NSAIDs and opioids.

British Society for Allergy and Clinical Immunology guidelines for the management of drug allergy

Source: bsaci.org
Clinical Resource: Guideline
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Last Checked: 08/05/15 Link Error: Report It

 

International Consensus on drug allergy

The use of standardized systematic approaches for the diagnosis and management of drug hypersensitivity reactions carries the potential to improve outcomes and should thus be disseminated and implemented. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the World Allergy Organization (WAO), has decided to issue an International CONsensus (ICON) on drug allergy.

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 08/05/14 Link Error: Report It

 

Drug Allergy: An Updated Practice Parameter

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.

Source: aaaai.org
Clinical Resource: Practice Parameter
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Last Checked: 08/05/15 Link Error: Report It

 

National Institute for Health and Care Excellence (NICE) Guidance > Drug allergy: diagnosis and management of drug allergy in adults, children and young people

Source: nice.org.uk
Clinical Resource: Guidance
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Last Checked: 18/05/15 Link Error: Report It

 

 

Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 15/04/14 Link Error: Report It

 

Desensitization in delayed drug hypersensitivity reactions – an European Academy of Allergy and Clinical Immunology position paper of the Drug Allergy Interest Group

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 08/05/14 Link Error: Report It

 

Drug Allergies

Adverse drug reactions (ADRs) are broadly divided into predictable (related to pharmacologic actions of the drug in otherwise normal individuals) and unpredictable reactions (related to individual’s immunological response and, on occasion, to genetic differences in susceptible patients). Drug allergy is a type of unpredictable reaction.

The term "drug hypersensitivity" refers to objectively reproducible symptoms or signs initiated by exposure to a drug at a dose normally tolerated by non-hypersensitive persons. "Drug allergy" refers to immunologically mediated drug hypersensitivity reactions. These may be either immunoglobulin E (IgE)–mediated (immediate) or non–IgE-mediated (delayed) hypersensitivity reactions.

Source: worldallergy.org
Clinical Resource: Summary
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Last Checked: 15/04/14 Link Error: Report It

 

Adverse Reactions to Antibacterial Agents

Antibacterial hypersensitivity is common and most frequently involves beta-lactam agents. While many non-specific reactions are labelled as ’allergic’, true type I (IgE-mediated) antibiotic hypersensitivity is indicated by the development of urticaria, angioedema, bronchospasm, or anaphylaxis (with objectively demonstrated hypotension, hypoxia or tryptase elevation) within one hour of drug administration.

Source: asainc.net.au
Clinical Resource: Newsletter
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Last Checked: 15/04/14 Link Error: Report It

 

Update on the evaluation of hypersensitivity reactions to betalactams

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 15/04/14 Link Error: Report It

 

What is the cross-reactivity of cephalosporins and carbapenems in a patient with a penicillin allergy?

Source: uic.edu
Clinical Resource: Frequently Asked Question
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Last Checked: 04/12/15 Link Error: Report It

 

Cross-reactivity of beta-lactam antibiotics

The purpose of this paper is to discuss the available data concerning the safety of administering cephalosporins, carbapenems, and monobactams to penicillin-allergic patients.

Source: baylorhealth.edu
Clinical Resource: Journal Article
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Last Checked: 15/04/14 Link Error: Report It

 

Penicillin allergy cross-reactivity

  • Roughly 10% of the population report allergy to penicillin
  • Penicillin is a beta-lactam antibiotic and can therefore cross-react with other beta-lactam antibiotics
Source: med.umkc.edu
Clinical Resource: Reference Material
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Last Checked: 15/04/14 Link Error: Report It

 

Cephalosporin Administration to Patients With a History of Penicillin Allergy

Penicillins and cephalosporins share a common beta-lactam ring structure, and hence the potential for IgE-mediated allergic cross-reactivity. Allergic cross-reactivity between penicillins and cephalosporins potentially may also occur due to presence of identical or similar R-group side chains, in which case IgE is directed against the side chain, rather the core beta-lactam structure. This work group report will address the administration of cephalosporins in patients with a history of penicillin allergy.

Source: aaaai.org
Clinical Resource: Archived Report
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Last Checked: 08/05/15 Link Error: Report It

 

“Sulfur allergy”

The term “sulfur allergy” is confusing and may lead to patients believing that they are allergic to all sulfur-containing medications or preservatives, and even to sulfur, an important building block of life. We are often asked, “Can a patient with a sulfur allergy have medication containing sulfur?” and, “What other drugs is the patient likely to be allergic to?” The aim of this bulletin is to clarify the term “sulfur allergy” and the allergies sometimes grouped together under this mantle; sulfonamide, sulfite and sulfate allergies.

Source: druginformation.co.nz
Clinical Resource: Drug Information Service Bulletin
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Last Checked: 15/04/14 Link Error: Report It

 

'Sulfur allergy' label is misleading

The term 'sulfur allergy' is misleading and dangerous and should not be used. an allergy to a sulfonamide antibiotic may imply cross-reactivity with other sulfonamide antibiotics, but does not imply cross-reactivity with non-antibiotic sulfonamides or other drugs containing sulfhydryl or sulfate groups.

Source: nps.org.au
Clinical Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

Sulfonamide Cross-Reactions Explained

A frequent question received by SDIS is “What drug can be used by a patient with a sulfa allergy”? The most common approach to this problem is avoidance of all sulfonamides. Analysis of the literature, however, indicates that cross-reaction among different classes of sulfonamide drugs is unlikely to occur; thus we may be withholding appropriate therapies from patients unnecessarily.

Source: usask.ca
Clinical Resource: Drug Information Services Newsletter
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Last Checked: 15/04/14 Link Error: Report It

 

Opioid Allergic Reactions

Patient reports of opioid “allergies” are common, most often due to symptoms of nausea, vomiting, itching, hypotension, or constipation. This Fast Fact will review signs, symptoms, and management options of opioid allergies and pseudo-allergies.

Source: mypcnow.org
Clinical Resource: Summary
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Last Checked: 02/03/16 Link Error: Report It

 

Opioids: Allergy vs. Pseudoallergy

This article briefly discusses the true opioid allergy versus pseudoallergy, opioid side effects, and alternative options to control pain.

Source: uspharmacist.com
Clinical Resource: Journal Article
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Last Checked: 05/01/15 Link Error: Report It

 

Opioid Allergies and Cross-reactivity

How many times have you had a patient with an allergy to codeine described as stomach upset? Or how about a rash with morphine (probably secondary to histamine release)?

Source: umem.org
Clinical Resource: Educational Pearl
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Last Checked: 05/01/15 Link Error: Report It

 

Q: Can fentanyl be prescribed for a patient allergic to codeine

A: Opioid analgesics are among the most commonly prescribed drugs in the United States. True allergic reactions to opioid analgesics are extremely rare, dependent upon antibody (usually IgE/IgG), and triggered by histamine and other mediators

Source: duq.edu
Clinical Resource: Pharmaceutical Information Centre Publication
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Last Checked: 15/04/14 Link Error: Report It

 

Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 08/05/14 Link Error: Report It

 

Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) – classification, diagnosis and management: review of the EAACI/ENDA and GA2LEN/HANNA

The aim of this review prepared by a group of experts representing the EAACI/ENDA group and GA2LEN Network of Excellence is to present up-to-date information on the pathomechanisms and clinical spectrum of hypersensitivity reactions caused by NSAIDs. Additionally, practical recommendations for proper diagnosis and management of patients with NSAIDs hypersensitivity are proposed.

Source: eu.wiley.com
Clinical Resource: Guideline
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Last Checked: 15/04/14 Link Error: Report It

 

 

Cross-Reactivity of ACE Inhibitor–Induced Angioedema with ARBs

Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are highly utilized classes of medications that affect the renin-angiotensin-aldosterone system (RAAS). Both have been shown to be beneficial in the treatment of disease states--such as hypertension, chronic heart failure, chronic kidney disease, and myocardial infarction--in which the RAAS system plays a significant role.

Source: uspharmacist.com
Clinical Resource: Journal Article
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Last Checked: 15/04/14 Link Error: Report It

 

Can angiotensin receptor blockers (ARBs) be administered to patients who develop angioedema on angiotensin-converting enzyme inhibitor (ACEI) therapy?

Source: uic.edu
Clinical Resource: Frequently Asked Question
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Last Checked: 04/12/15 Link Error: Report It

 

'Iodine allergy' label is misleading

'Iodine allergy' is not an accurate label for patients who have had allergic reactions to iodinated radiological contrast media or iodinated antiseptics. Allergy to seafood has nothing to do with iodine content as it is caused by specific immunoglobulin E to proteins.

Source: nps.org.au
Clinical Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

Q: Is there a risk in using amiodarone in patients with iodine hypersensitivity?

A: Amiodarone is a popular drug for the treatment of supraventricular and ventricular arrhythmias. Each 200 mg tablet contains 75 mg (37.3%) of iodine. The product literature includes a contraindication to its use in patients with hypersensitivity to iodine. The question arises, what is iodine hypersensitivity?

Source: duq.edu
Clinical Resource: Pharmaceutical Information Centre Publication
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Last Checked: 15/04/14 Link Error: Report It

 

Q: Can a patient with an allergic reaction to one PPI be re-challenged with another drug in the same category?

A: Cross-reactivity among the proton-pump inhibitors (PPIs) has been documented in several case reports. With the exception of lansoprazole, the product labeling for each of these agents describes them as contraindicated in patients with known hypersensitivity to PPIs or other substituted benzimidazoles.

Source: duq.edu
Clinical Resource: Pharmaceutical Information Centre Publication
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Last Checked: 15/04/14 Link Error: Report It

 

British Society for Allergy and Clinical Immunology guidelines for the investigation of suspected anaphylaxis during general anaesthesia

Source: bsaci.org
Clinical Resource: Guideline
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Last Checked: 08/05/15 Link Error: Report It

 

Allergy to Anesthetic Agents

Anesthesia represents a pharmacologically unique situation, during which patients are exposed to multiple foreign substances including anesthetics, analgesics, antibiotics, antiseptics, blood products, heparin, polypeptides, and intravascular volume expanders, which can produce immediate hypersensitivity reactions or anaphylaxis.

Since no preemptive therapeutic strategies exist, both vigilance of the attending clinicians to rapidly recognize and treat these reactions and subsequent allergological investigations to identify the offending agent and prevent recurrences, are of critical importance.

Source: worldallergy.org
Clinical Resource: Summary
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Last Checked: 08/05/14 Link Error: Report It

 

How should allergic reactions to local anesthetics be managed?

Source: uic.edu
Clinical Resource: Frequently Asked Question
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Last Checked: 04/12/15 Link Error: Report It

 

Pharmaceutical excipients – where do we begin?

Excipients have been defined in many ways, including as inert substances used as vehicles and diluents for drugs. The problem with this definition is that in recent years excipients have proved to be anything but inert, not only possessing the ability to react with other ingredients in the formulation, but also to cause adverse and hypersensitivity reactions in patients.

Source: nps.org.au
Clinical Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

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