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Drug Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
The spectrum of drug allergy has evolved overtime. There is a broad range of adverse drug reactions including immunologic and non-immunologic reactions. The exact mechanisms of drug allergy are currently unknown. A detailed clinical history is crucial in the diagnosis of drug allergy.
Treatment of Anaphylaxis
Published in Kirsti Kauppinen, Kristiina Alanko, Matti Hannuksela, Howard Maibach, Skin Reactions to Drugs, 2020
After recovery from severe anaphylactic reactions, patients should be followed up at the hospital for 24 hours because relapses are possible. The patient may benefit from peroral steroids after an acute anaphylactic episode. The identification of the agent causing anaphylaxis is extremely important for prophylaxis. Details on the specific drug allergy should be indicated in medical records. If possible, the patient should be informed about possible cross-reactions. If the exposure to the allergen is unavoidable, epinephrine can be prescribed for self-administration as an intramuscular injection (1 mg/ml; 0.3 to 0.5 mg intramuscularly) or as inhalation (10 to 20 inhalations; 0.15 mg/puff).12 During anesthesia, in cases with previous anaphylactic episodes, corticosteroids and histamine H1 and H2 blockers used simultaneously may prevent cardiorespiratory collapse and hypotonia.4,13 Very mild cases (pruritus, skin manifestations) can be treated with peroral hydrocortisone and antihistamines.
Basic Principles of Antibiotic Treatment
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
For serious and life-threatening infections, use of bactericidal agents (e.g. β-lactams) would generally be preferred over bacteriostatic agents (e.g. lincosamines). Drug allergy history must be carefully sought from patient and records prior to initiation of therapy. Certain classes of antibiotics may need to be avoided or used with caution in patients with underlying conditions (e.g. aminoglycosides in patients with renal failure).
Ultrasound -guided erector spinae plane block (ESPB) versus intravenous opioids based analgesia in patients with rib fractures
Published in Egyptian Journal of Anaesthesia, 2023
Soha Elmansy, Mohammed Abdelkhalek, Sherif Farouk, Randa Shoukry, Ahmed Khames
Patients who refused the intervention or participation in this study.Patients who could not achieve effective communication.Patients with a fractured sternum.Bleeding disorders.Relevant drug allergy.Significant lung or pleural injuries.Significant traumatic injuries, e.g., pelvic or spine fractures, injuries of the abdominal viscera, or severe injuries affecting the spinal cord or the brain.Intubated patients.Local infection at the site of intervention.
Self-reported beta-lactam intolerance: not a class effect, dangerous to patients, and rarely allergy
Published in Expert Review of Anti-infective Therapy, 2019
Penicillin is still the most commonly reported drug allergy. There is likely no clinically significant immunologically mediated cross-reactivity between unconfirmed penicillin allergy and other beta-lactams. Unconfirmed penicillin ‘allergy’ leads to substantial harm to patients, increased adverse reactions to second-line agents, increased hospitalization, and increased morbidity from Cdiff, VRE, and MRSA. Beta-lactam-associated anaphylaxis and SCARs are much rarer than commonly feared. A structured history of the penicillin-associated reaction will place patients into low-risk, higher-risk, and absolutely contraindicated groups. Low-risk patients can safely undergo a direct oral amoxicillin challenge to confirm current tolerance [48]. Higher-risk patients warrant Allergy or other specialist consultation able to perform penicillin skin testing prior to an oral amoxicillin challenge to confirm current tolerance. Patients with a confirmed beta-lactam allergy, who need that specific beta-lactam for a life-threatening infection, can safely undergo desensitization. Only patients with SCARs or SSIMRs need continued avoidance.
Diagnosis of drug causality in non-immediate drug hypersensitivity in children
Published in Expert Review of Clinical Pharmacology, 2018
François Graham, Jean-Christoph Caubet
Non-BL antibiotics are another common cause of drug allergy in children, the most frequently incriminated being cotrimoxazole and macrolides [31]. In addition, quinolone allergies are increasingly reported due to their frequent use in children with cystic fibrosis [32]. The value of STs for non-BLs in children remains largely unknown, although non-irritating doses have been described in adult populations [33]. Delayed reading IDTs followed by DPT remain the classical approach when evaluating children with non-immediate mild reactions to non-BLs, even if the sensitivity and PPV of these STs is not well established. Future studies are urgently required to evaluate whether direct DPTs without STs is safe for non-immediate mild reactions to non-BLs, and to determine the optimal DPT protocols for non-BLs.