Evaluating Penicillin Allergies Without Skin Testing

AbstractPurpose of ReviewAn unconfirmed penicillin allergy is known to confer significant risk to patients. Only a small minority of patients labeled with penicillin allergy will be confirmed to be hypersensitive with the current reference standard test, an oral amoxicillin therapeutic dose challenge. Skin testing has been recommended prior to oral challenges to reduce the risk of severe acute challenge reactions. The rate of severe acute anaphylactic reactions with oral amoxicillin is currently extremely low. Unfortunately, penicillin skin testing, as commonly performed, has a high rate of false positive results.Recent FindingsEncouraging skin testing in all individuals with an unconfirmed penicillin allergy, prior to a confirmatory oral challenge, would be technically difficult, make testing all individuals with an unconfirmed penicillin allergy very unlikely, and ultimately increase the risk to patients because of suboptimal antibiotic use. Most patients, who are appropriate candidates for a direct oral amoxicillin challenge, to confirm current penicillin tolerance, can be safely identified by their clinical histories. Higher risk individuals, those with a history of anaphylaxis or other acute onset potentially IgE-mediated reaction such as hives within 6  h of the first dose of the last course of a penicillin, may benefit from properly performed puncture and intradermal skin testing, using commercially available penicilloyl-polylysine, prior to an oral challenge, if ...
Source: Current Allergy and Asthma Reports - Category: Allergy & Immunology Source Type: research

Related Links:

This article was originally published on Undark. Read the original article.
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized allergies health onetime syndication Source Type: news
Drug-induced hypersensitivity reactions are of major medical concern. Approximately 45% of all the adverse drug reactions are manifested in the skin, which occur in 2%-3% hospitalized patients upon drug administration1. Drug hypersensitivity reactions can be categorized into immediate reactions and delayed reactions. Immediate reactions occur within minutes or hours of drug exposure 2. The manifestations of immediate-type reactions range from pruritus, urticaria, angioedema to anaphylaxis. The delayed-type reactions are primarily T cell-mediated type IV reactions that usually takes several days or even weeks to manifest after drug exposure.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
Abstract Gluten-related disorders are very common in pediatric patients. Wheat allergy is triggered by an immunoglobulin E (IgE)-dependent mechanism; its prevalence varies according to the age and region, and in Europe has been estimated to be lower than 1%. Many studies investigated the potential role of several external factors that can influence the risk to developing wheat allergy, but results are still inconclusive. It can be responsible for several clinical manifestations depending on the route of allergen exposure: food-dependent exercise-induced anaphylaxis (FDEIA), occupational rhinitis or asthma (also kn...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
AbstractBackgroundPlatelet activating factor (PAF) is an endogenous, active phospholipid released from inflammatory cells, platelets, and endothelial cells, and is involved in the regulation of immune responses. Degradation of PAF by PAF acetylhydrolase (PAF-AH) has been shown to be associated with anaphylaxis, asthma, and peanut allergy. The purpose of this study was to investigate relationships among clinical parameters, including urticaria severity and treatment responsiveness, and PAF and PAF-AH levels in sera from patients with chronic spontaneous urticaria (CSU).MethodsSerum PAF and PAF-AH levels were measured by enz...
Source: Clinical and Translational Allergy - Category: Allergy & Immunology Source Type: research
Purpose of review Nonsteroidal anti-inflammatory drug (NSAID) is one of the most frequently prescribed medications in the medical field, and hypersensitivity to NSAID is a common adverse drug reaction encountered. However, NSAID hypersensitivity presents a variety of symptoms caused by diverse pharmacological and immunological mechanisms. Recent findings Owing to the heterogeneity of the disease, a new concept for the classification of NSAID hypersensitivity has recently been proposed to diagnose and manage NSAID hypersensitivity for personalized treatment. Acute and delayed reactions were distinguished in this classi...
Source: Current Opinion in Allergy and Clinical Immunology - Category: Allergy & Immunology Tags: DRUG ALLERGY: Edited by Miguel Blanca and Paul Whitaker Source Type: research
CONCLUSIONS: The rate of anaphylaxis in patients with ColdU in a tropical country was lower than those reported by other studies conducted intemperate climates. On the other hand, the number of female patients, mean age at symptom onset, atopy rate, rate of concomitant chronic spontaneous urticaria and mean CTT were higher. PMID: 31172722 [PubMed]
Source: Allergy, Asthma and Immunology Research - Category: Allergy & Immunology Tags: Allergy Asthma Immunol Res Source Type: research
Allergy to galactose-alpha-1,3-galactose (alpha-gal) presents as an IgE-mediated, yet delayed-onset hypersensitivity reaction to non-primate mammalian meat.1 Alpha-gal sensitization develops after tick bite exposure.1-3 The lone-star tick (Amblyomma americanum) represents the North American vector, spanning a relatively vast southeast, mid-west, and northeast geographic distribution.4 Allergic manifestations include urticaria/angioedema, abdominal pain/diarrhea, or anaphylaxis, occurring approximately 3-6 hours after ingestion.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Letters Source Type: research
Recently, new diagnostic tools and therapeutic agents have significantly increased the survival rate of cancer patients compared to that in the past. As the number of cancer survivors exposed to multiple courses of chemotherapy increases, more patients become sensitized to chemotherapeutic agents and suffer from hypersensitivity reactions (HSRs).1-3 HSRs to chemotherapeutic agents range from mild cutaneous urticaria to severe reactions, such as life-threatening anaphylaxis, and even death.4 Most HSRs are unpredictable, such that they threaten the safety of patients; moreover, they can be uncontrollable, and severe HSRs lim...
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
Thank you to you and your colleagues for your valuable and thoughtful paper, “Management of anaphylaxis and allergies in patients with long QT syndrome.”1 Because high-dose antihistamine therapy for chronic urticaria has become increasingly common, we have been considering what (if any) precautions should be taken before prescribing that to a patient, including such seem ingly “routine” measures (not routine in an allergist's office), such as getting an electrocardiogram on anyone getting an antihistamine, which is surely a lot of patients.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Correspondence Source Type: research
Aerobic exercises can precipitate inducible urticarias. Cholinergic urticaria and exercise-induced anaphylaxis are good examples of these triggers1-2. The same can happen in patients with delayed pressure urticaria when areas of the body are compressed during exercises3. To our knowledge, sexual intercourse has not been documented for triggering inducible urticarias. We are presenting two cases of inducible urticaria precipitated by sexual intercourse: exercise-induced anaphylaxis and delayed pressure urticaria.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Letters Source Type: research
More News: Allergy | Allergy & Immunology | Amoxicillin | Anaphylactic Shock | Asthma | Hives | Penicillin | Skin