Materiały źródłowe

• #1 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Laboratory investigations are supportive and not confirmatory for most allergic drug reactions. […] In the diagnosis of a potential IgE-mediated reaction, validated skin testing reagents exist only for penicillin and not for any of the other low-molecular-weight drugs. […] The risk of or reacquiring a penicillin allergy is low after negative penicillin testing. […] In most cases of drug allergy, validated skin or laboratory tests are not available. […] For patients in whom the likelihood of drug allergy is deemed low (e.g., remote reaction, benign rash), a drug challenge can be performed by an allergist. […] Although adverse drug reactions are common, allergic reactions are uncommon.

• #2 Drug Allergy: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/8621-medication-allergies

  Drug allergies are an allergic reaction to medications. Its when your bodys immune system overreacts to medications. Your body develops a sensitivity to one of the substances in the medication and remembers it as a harmful foreign invader, like bacteria or viruses. The next time you ingest that drug, your immune system releases antibodies to remove it from your body. […] A drug allergy can be deadly. If you or a loved one have severe drug allergy symptoms, including swelling of your tongue or throat, trouble breathing, a fast heartbeat, lightheadedness or unconsciousness, you must act quickly: […] An allergist can diagnose a drug allergy. An allergist is a healthcare provider who specializes in diagnosing through tests and determining the best possible treatment. […] Depending on the drug your allergist suspects of causing the reaction, they may suggest a skin test. Skin testing is very helpful in diagnosing an allergy to penicillin-type medicines.

• #3 Drug Allergy Testing | NEW EL

  https://www.eastlansingallergy.org/general-9-2

  The majority of reactions caused by medications are more correctly termed adverse reactions to drugs. True drug allergies are rare and caused by the immune system. […] An allergic reaction is an abnormal response of the immune system to a normally harmless substance. People with a drug allergy have an over-sensitive immune system. Their immune system reacts to the drug as if it were an invader. The body’s immune system makes antibodies called Immunoglobulin E (IgE) antibodies. These IgE antibodies react with substances and cause allergy symptoms. […] Allergists often make a diagnosis based only upon the patient’s history and the symptoms involved. This is what we call a clinical diagnosis. […] Allergy tests can only be useful when the reaction is a true allergic reaction. For specific medications, testing is available to check for IgE. The doctor will consider your medical history, your symptoms and any test results to make a diagnosis.

• #4 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  An accurate diagnosis is essential. Research has suggested that drug allergies may be overdiagnosed and that patients may report drug allergies that have never been confirmed. Misdiagnosed drug allergies may result in the use of less appropriate or more-expensive medicines. […] A healthcare professional typically does a physical exam and asks you questions. Details about when symptoms started, the time you took the medicine, and improvement or worsening of symptoms are important clues for helping your health professional make a diagnosis. […] Your health professional may order more tests or refer you to an allergy specialist, called an allergist, for tests. These may include the following. […] A positive result suggests that you may have a drug allergy. […] A negative result isn’t as clear-cut. For some medicines, a negative test result usually means that you’re not allergic to the medicine. For other medicines, a negative result may not completely rule out the possibility of a drug allergy.

• #5 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  A thorough exam and appropriate diagnostic tests are essential for an accurate diagnosis. A misdiagnosed penicillin allergy may result in the use of less-appropriate or more-expensive antibiotics. […] Your doctor will conduct a physical examination, ask questions about your symptoms and order additional tests. You may be referred to an allergy specialist (allergist) for these tests. These may include the following. […] A positive result indicates a high likelihood of penicillin allergy. A negative test result usually means you’re not at high risk of an allergy to penicillin. But a negative result is more difficult to interpret because some kinds of drug reactions cannot be detected by skin tests. […] If the diagnosis of a penicillin allergy is uncertain, a graded drug challenge may be recommended.

• #6 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Cutaneous manifestations are the most common presentation of allergic drug reactions. […] Diagnosis of drug allergy is largely based on clinical history because diagnostic tests are limited. […] Most patients who are labelled as having penicillin allergy can tolerate penicillins after allergy evaluation. […] Cross-reactivity between cephalosporins and penicillins is rare. […] Maculopapular rashes with amoxicillin are common and not an absolute contraindication for future use. […] The approach to diagnosis begins with the patients medical history, which may identify the etiology of the reaction, identify drug allergy as a possible cause of symptoms and provide details suggesting the possible type of drug-induced allergic reaction. […] The Naranjo Adverse Drug Reaction Probability Scale can be used, based on the patients history, as a validated probability scale to help determine the likelihood that the symptoms described represent an adverse drug reaction.

• #7 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  An accurate diagnosis is essential. Research has suggested that drug allergies may be overdiagnosed and that patients may report drug allergies that have never been confirmed. Misdiagnosed drug allergies may result in the use of less appropriate or more-expensive medicines. […] A healthcare professional typically does a physical exam and asks you questions. Details about when symptoms started, the time you took the medicine, and improvement or worsening of symptoms are important clues for helping your health professional make a diagnosis. […] Your health professional may order more tests or refer you to an allergy specialist, called an allergist, for tests. These may include the following. […] A positive result suggests that you may have a drug allergy. […] A negative result isn’t as clear-cut. For some medicines, a negative test result usually means that you’re not allergic to the medicine. For other medicines, a negative result may not completely rule out the possibility of a drug allergy.

• #8 Drug allergy | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0289-y

  Diagnosis requires a thorough drug history, including dates of administration, drug formulation, dosage and route of administration, as well as clinical symptoms and their timing and duration in relation to drug exposure; skin testing and graded challenges may also be required. […] The mainstay of treatment for drug allergy is avoidance of the offending drug. […] If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, induction of drug tolerance procedures may be considered to induce temporary tolerance to the drug.

• #9 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  In this review, we will focus on drug allergic reactions, specially on the tools available for the allergological workup used to gather evidence supporting specific immune responses and for identification of inciting drugs in immunoglobulin IgE- and T cell-mediated allergies. […] Accurate diagnosis of specific clinical entities is key for identification of potential culprits. An exhaustive description of criteria for differential diagnosis is beyond the scope of this review. […] The first step in the diagnosis approach to drug allergy is to suspect a hypersensitivity reaction to an administered drug. A precise description of the morphology and chronology of the reaction is mandatory. […] The diagnosis of drug allergic reactions also requires knowledge of the scientific literature, including access to Medline searches to look up a particular compound and a specific hypersensitivity reaction. The literature can be especially relevant in the case of SCARs and in reactions with new drugs that have recently been marketed.

• #10 Medication Allergy Testing | National Jewish Health

  https://www.nationaljewish.org/conditions/medication-allergy/treatment

  Every diagnosis begins with a detailed medical history and physical examination. The doctor will ask lots of questions about the nature of the reaction, such as if the person had taken the medication or a similar medication before, how long the person was on the medication, timing of the dose, onset of symptoms and the nature and evolution of the symptoms. […] The gold standard for testing for a drug allergy is doing a drug challenge. […] Depending upon the findings of the initial evaluation, the following tests may be necessary: Allergy skin testing may be performed to check for presence of allergic antibodies to selected drug allergens. Patch skin testing can also be performed. Blood testing is occasionally indicated. Sometimes a challenge to the suspected drug is necessary to confirm the diagnosis. If indicated, drug challenges are coordinated with safety as the highest priority.

• #11 Drug Allergies | Reactions, Symptoms & Treatment | ACAAI Public Website

  https://acaai.org/allergies/allergic-conditions/drug-allergies/

  If you develop a rash, hives or difficulty breathing after taking certain medications, you may have a drug allergy. […] People with drug allergies may experience symptoms regardless of whether their medicine comes in liquid, pill or injectable form. If you feel confused about your symptoms and which medications are safe for you to take then it’s time to take control and see an allergist. […] Diagnosing Drug Allergies […] Drug allergies can be hard to diagnose. An allergy to penicillin-type drugs is the only one that can be definitively diagnosed through a skin test. […] Your allergist will also want to know whether you have had a reaction to any other drug. If you can, bring the suspected drug with you. This will help the allergist recommend alternatives as needed. […] Depending on the drug suspected of causing the reaction, your allergist may suggest a skin test or, in limited instances, a blood test.

• #12 Adverse Drug Reactions: Types and Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1101/p1781.html

  Drug hypersensitivity results from interactions between a pharmacologic agent and the human immune system. These types of reactions constitute only a small subset of all adverse drug reactions. Allergic reactions to medications represent a specific class of drug hypersensitivity reactions mediated by IgE. Drug hypersensitivity is a clinical diagnosis based on available data. Laboratory testing may be useful, with skin testing providing the greatest specificity. Identifiable risk factors for drug hypersensitivity reactions include age, female gender, concurrent illnesses, and previous hypersensitivity to related drugs. […] Identifying true drug allergy, however, can be challenging. Complicating factors of drug reactions include the myriad clinical symptoms and multiple mechanisms of drug-host interaction, many of which are poorly understood. In addition, the relative paucity of laboratory testing that is available for drug allergy makes the diagnosis dependent on clinical findings.

• #13 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Cutaneous manifestations are the most common presentation of allergic drug reactions. […] Diagnosis of drug allergy is largely based on clinical history because diagnostic tests are limited. […] Most patients who are labelled as having penicillin allergy can tolerate penicillins after allergy evaluation. […] Cross-reactivity between cephalosporins and penicillins is rare. […] Maculopapular rashes with amoxicillin are common and not an absolute contraindication for future use. […] The approach to diagnosis begins with the patients medical history, which may identify the etiology of the reaction, identify drug allergy as a possible cause of symptoms and provide details suggesting the possible type of drug-induced allergic reaction. […] The Naranjo Adverse Drug Reaction Probability Scale can be used, based on the patients history, as a validated probability scale to help determine the likelihood that the symptoms described represent an adverse drug reaction.

• #14 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  After the carefully taken anamnesis, the allergists will know whether the reaction they are dealing with is a probable immediate or non-immediate drug allergic reaction, its phenotype, and which tools should be used to identify the culprit drug. […] During the acute phase of the reaction, there is general agreement to not perform skin testing. The only tools used to identify the culprit drug will be the clinical history and the algorithms of causality assessment, which are of great relevance in SCARs and other DHRs. […] Various methods have been proposed to evaluate the causal relationship between an adverse event and the medication taken by the patient. The algorithm methods are primarily based on decision trees or consecutive answers to specific questions, resulting in a sum of scores.

• #15 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Cutaneous manifestations are the most common presentation of allergic drug reactions. […] Diagnosis of drug allergy is largely based on clinical history because diagnostic tests are limited. […] Most patients who are labelled as having penicillin allergy can tolerate penicillins after allergy evaluation. […] Cross-reactivity between cephalosporins and penicillins is rare. […] Maculopapular rashes with amoxicillin are common and not an absolute contraindication for future use. […] The approach to diagnosis begins with the patients medical history, which may identify the etiology of the reaction, identify drug allergy as a possible cause of symptoms and provide details suggesting the possible type of drug-induced allergic reaction. […] The Naranjo Adverse Drug Reaction Probability Scale can be used, based on the patients history, as a validated probability scale to help determine the likelihood that the symptoms described represent an adverse drug reaction.

• #16 Editor’s Pick: A Review of Drug Allergies: Diagnosis and Management – European Medical Journal

  https://www.emjreviews.com/allergy-immunology/article/editors-pick-a-review-of-drug-allergies-diagnosis-and-management/

  The most common clinical manifestations of drug allergy are seen on the skin and sometimes mucous membranes. […] The most common cutaneous manifestation is generalised exanthema (as a maculopapular rash), which appears between a few days and 3 weeks after drug exposure, usually starting on the trunk and eventually spreading to the limbs. […] Diagnosis relies on a meticulous history and physical examination. Skin testing, and if warranted graded challenges of allergen, and induction of drug tolerance procedures may be required in some instances. […] The mainstay of treatment for drug allergy is avoidance of the offending drug. […] When available, alternative medications with unrelated chemical structures should be substituted. […] Cross-reactivity among drugs should be taken into consideration when choosing alternative medications. […] If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, procedures of induction of drug tolerance may be considered for producing temporary tolerance to the drug.

• #17 Editor’s Pick: A Review of Drug Allergies: Diagnosis and Management – European Medical Journal

  https://www.emjreviews.com/allergy-immunology/article/editors-pick-a-review-of-drug-allergies-diagnosis-and-management/

  The most common clinical manifestations of drug allergy are seen on the skin and sometimes mucous membranes. […] The most common cutaneous manifestation is generalised exanthema (as a maculopapular rash), which appears between a few days and 3 weeks after drug exposure, usually starting on the trunk and eventually spreading to the limbs. […] Diagnosis relies on a meticulous history and physical examination. Skin testing, and if warranted graded challenges of allergen, and induction of drug tolerance procedures may be required in some instances. […] The mainstay of treatment for drug allergy is avoidance of the offending drug. […] When available, alternative medications with unrelated chemical structures should be substituted. […] Cross-reactivity among drugs should be taken into consideration when choosing alternative medications. […] If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, procedures of induction of drug tolerance may be considered for producing temporary tolerance to the drug.

• #18 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Laboratory investigations are supportive and not confirmatory for most allergic drug reactions. […] In the diagnosis of a potential IgE-mediated reaction, validated skin testing reagents exist only for penicillin and not for any of the other low-molecular-weight drugs. […] The risk of or reacquiring a penicillin allergy is low after negative penicillin testing. […] In most cases of drug allergy, validated skin or laboratory tests are not available. […] For patients in whom the likelihood of drug allergy is deemed low (e.g., remote reaction, benign rash), a drug challenge can be performed by an allergist. […] Although adverse drug reactions are common, allergic reactions are uncommon.

• #19 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  An accurate diagnosis is essential. Research has suggested that drug allergies may be overdiagnosed and that patients may report drug allergies that have never been confirmed. Misdiagnosed drug allergies may result in the use of less appropriate or more-expensive medicines. […] A healthcare professional typically does a physical exam and asks you questions. Details about when symptoms started, the time you took the medicine, and improvement or worsening of symptoms are important clues for helping your health professional make a diagnosis. […] Your health professional may order more tests or refer you to an allergy specialist, called an allergist, for tests. These may include the following. […] A positive result suggests that you may have a drug allergy. […] A negative result isn’t as clear-cut. For some medicines, a negative test result usually means that you’re not allergic to the medicine. For other medicines, a negative result may not completely rule out the possibility of a drug allergy.

• #20 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Laboratory investigations are supportive and not confirmatory for most allergic drug reactions. […] In the diagnosis of a potential IgE-mediated reaction, validated skin testing reagents exist only for penicillin and not for any of the other low-molecular-weight drugs. […] The risk of or reacquiring a penicillin allergy is low after negative penicillin testing. […] In most cases of drug allergy, validated skin or laboratory tests are not available. […] For patients in whom the likelihood of drug allergy is deemed low (e.g., remote reaction, benign rash), a drug challenge can be performed by an allergist. […] Although adverse drug reactions are common, allergic reactions are uncommon.

• #21 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  After looking at your symptoms and test results, a healthcare professional can usually reach one of the following conclusions: You have a drug allergy. You don’t have a drug allergy. You may have a drug allergy with varying degrees of certainty. […] If you have a confirmed drug allergy, a healthcare professional likely would not prescribe the medicine that causes a reaction unless it is necessary. Sometimes if the diagnosis of drug allergy is uncertain or there’s no other treatment your health professional may use one of two strategies to give you the suspect medicine. […] If the diagnosis of a drug allergy is uncertain and a healthcare professional judges that an allergy is unlikely, a graded drug challenge may be an option. […] If it’s necessary for you to take a medicine that has caused an allergic reaction, your care professional may recommend a treatment called drug desensitization.

• #22 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  The main caveat when using these algorithms is that they were primarily developed to assess drug causality in type A (on-target) adverse drug reactions, with drug allergies being mostly type B (off-target) reactions and some severe, in which re-exposures are largely contraindicated. […] Although drug challenge is the gold standard technique to confirm or discard a drug allergy, due to safety concerns, it is used when all the available alternative tests (in vivo and in vitro) are negative, considering the patients comorbidities and the necessity and utility of achieving an accurate diagnosis. […] Skin tests (prick and intradermal) and patch testing are useful in vivo tools used for etiologic diagnosis of drug allergy. […] Skin testing is the primary diagnostic tool for identifying patients with IgE- or T cell-mediated reactions to drugs.

• #23 Drug Allergy Testing | Frontier Allergy Austin

  https://www.frontierallergist.com/testing-treatments/drug-allergy-testing/

  After a discussion of your medical, allergy, and family history, your allergy specialist will perform a physical exam and determine which testing method(s) to use. […] Patients may either undergo a skin prick test or an intradermal skin test. During a skin prick test, a small amount of a suspect drug is administered to the skin and scratched with a plastic applicator. During an intradermal skin test, a small amount of a suspect drug is injected just under the skin using a small needle. Both of these tests require a 15-20 minute wait for the skin to react, followed by physician observation for raised, red, itchy bumps (called wheals). A positive result generally indicates a drug allergy, but a negative skin test does not definitively rule out an allergy to a drug. However, at Frontier Allergy Asthma and Immunology, your physician will take the necessary next steps to help you determine whether or not you may have a true drug allergy.

• #24 Drug Allergy Testing | Frontier Allergy Austin

  https://www.frontierallergist.com/testing-treatments/drug-allergy-testing/

  After a discussion of your medical, allergy, and family history, your allergy specialist will perform a physical exam and determine which testing method(s) to use. […] Patients may either undergo a skin prick test or an intradermal skin test. During a skin prick test, a small amount of a suspect drug is administered to the skin and scratched with a plastic applicator. During an intradermal skin test, a small amount of a suspect drug is injected just under the skin using a small needle. Both of these tests require a 15-20 minute wait for the skin to react, followed by physician observation for raised, red, itchy bumps (called wheals). A positive result generally indicates a drug allergy, but a negative skin test does not definitively rule out an allergy to a drug. However, at Frontier Allergy Asthma and Immunology, your physician will take the necessary next steps to help you determine whether or not you may have a true drug allergy.

• #25 Drug Allergy Testing | Frontier Allergy Austin

  https://www.frontierallergist.com/testing-treatments/drug-allergy-testing/

  If you do not have an immediate allergic reaction to any drug(s) during the physician-supervised skin test, your doctor may recommend undergoing a patch test. Patch testing is a way for your doctor to observe any delayed allergic reactions you may have to certain drugs. A patch test involves taping a small amount of the drug in a chamber onto the back. After 48-72 hours of keeping the area dry and undisturbed, you will return to the office for patch removal and examination of your results. […] Based on the results of your previous tests, your doctor may recommend undergoing an oral drug challenge. This test is performed in a healthcare setting under your physician’s supervision. In this challenge, you will ingest increasing amounts of a drug until a reaction occurs (for which you will immediately be treated with medication) or tolerance can be verified.

• #26 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  Various methods have been proposed to evaluate the causal relationship between an adverse event and the medication taken by the patient. […] Although drug challenge is the gold standard technique to confirm or discard a drug allergy, due to safety concerns, it is used when all the available alternative tests (in vivo and in vitro) are negative, considering the patient’s comorbidities and the necessity and utility of achieving an accurate diagnosis. […] Skin tests (prick and intradermal) and patch testing are useful in vivo tools used for etiologic diagnosis of drug allergy. […] The epicutaneous test (or patch test) is a valuable diagnostic tool to identify the culprit drug after delayed DHRs. […] If in vitro tests and epicutaneous/skin tests are negative, a drug challenge with the suspect agent might be the only way to discard or confirm its imputability.

• #27 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  The value of skin testing depends on the specific drug. Skin tests are very useful in diagnosing immediate hypersensitivity reactions induced by beta-lactams, iodinated radiocontrast media, proton pump inhibitors, high molecular weight heparins, corticosteroids, and platinum compounds. […] Although the LTT has been used for more than three decades to investigate drug sensitization in non-immediate reactions, its usefulness in SJS/TEN is still controversial. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] HLA testing prior to drug administration can be used as a tool to prevent severe hypersensitivity reactions in patients at risk.

• #28 Drug Allergies | Reactions, Symptoms & Treatment | ACAAI Public Website

  https://acaai.org/allergies/allergic-conditions/drug-allergies/

  If you develop a rash, hives or difficulty breathing after taking certain medications, you may have a drug allergy. […] People with drug allergies may experience symptoms regardless of whether their medicine comes in liquid, pill or injectable form. If you feel confused about your symptoms and which medications are safe for you to take then it’s time to take control and see an allergist. […] Diagnosing Drug Allergies […] Drug allergies can be hard to diagnose. An allergy to penicillin-type drugs is the only one that can be definitively diagnosed through a skin test. […] Your allergist will also want to know whether you have had a reaction to any other drug. If you can, bring the suspected drug with you. This will help the allergist recommend alternatives as needed. […] Depending on the drug suspected of causing the reaction, your allergist may suggest a skin test or, in limited instances, a blood test.

• #29 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Laboratory investigations are supportive and not confirmatory for most allergic drug reactions. […] In the diagnosis of a potential IgE-mediated reaction, validated skin testing reagents exist only for penicillin and not for any of the other low-molecular-weight drugs. […] The risk of or reacquiring a penicillin allergy is low after negative penicillin testing. […] In most cases of drug allergy, validated skin or laboratory tests are not available. […] For patients in whom the likelihood of drug allergy is deemed low (e.g., remote reaction, benign rash), a drug challenge can be performed by an allergist. […] Although adverse drug reactions are common, allergic reactions are uncommon.

• #30 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  An accurate diagnosis is essential. Research has suggested that drug allergies may be overdiagnosed and that patients may report drug allergies that have never been confirmed. Misdiagnosed drug allergies may result in the use of less appropriate or more-expensive medicines. […] A healthcare professional typically does a physical exam and asks you questions. Details about when symptoms started, the time you took the medicine, and improvement or worsening of symptoms are important clues for helping your health professional make a diagnosis. […] Your health professional may order more tests or refer you to an allergy specialist, called an allergist, for tests. These may include the following. […] A positive result suggests that you may have a drug allergy. […] A negative result isn’t as clear-cut. For some medicines, a negative test result usually means that you’re not allergic to the medicine. For other medicines, a negative result may not completely rule out the possibility of a drug allergy.

• #31 Drug Allergy Testing | NEW EL

  https://www.eastlansingallergy.org/general-9-2

  One of the most reliable tests we have is the test for penicillin allergy. […] Sometimes the allergist will do a drug challenge. A drug challenge is a test where the allergist gives you a small amount of a drug in gradual doses while observing you to watch for a reaction. If you have a true allergy or a suspected allergy to a drug, stop taking the drug. […] A positive result suggests you may have a drug allergy. A negative result isn’t as clear-cut. For some drugs, a negative test result usually means that you’re not allergic to the drug. For other drugs, a negative result may not completely rule out the possibility of a drug allergy. […] While there are blood tests for detecting allergic reactions to a few drugs, these tests aren’t used often because of the relatively limited research on their accuracy.

• #32 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Laboratory investigations are supportive and not confirmatory for most allergic drug reactions. […] In the diagnosis of a potential IgE-mediated reaction, validated skin testing reagents exist only for penicillin and not for any of the other low-molecular-weight drugs. […] The risk of or reacquiring a penicillin allergy is low after negative penicillin testing. […] In most cases of drug allergy, validated skin or laboratory tests are not available. […] For patients in whom the likelihood of drug allergy is deemed low (e.g., remote reaction, benign rash), a drug challenge can be performed by an allergist. […] Although adverse drug reactions are common, allergic reactions are uncommon.

• #33 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  In vitro tests have the advantage over in vivo diagnostic tests of being safe. […] There are two categories of in vitro tests commonly used in the diagnosis of immediate DHRs: (1) histamine and tryptase determinations, which are not drug specific and are markers of type I hypersensitivity in general; and (2) identification of drug-specific IgE, and the basophil activation test, which are drug specific and can help to identify or confirm drug causality. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] An increasing number of studies have shown an association between specific HLA alleles and the development of delayed drug hypersensitivity reactions. […] There is currently no diagnostic tool that offers 100% NPV for immediate or delayed hypersensitivity reactions, and any decision to reintroduce a drug or another member of its drug class in the treatment setting should weigh the risk/benefit ratio.

• #34 Diagnosis of drug allergy a pending problem? | Allergologia et Immunopathologia

  https://www.elsevier.es/en-revista-allergologia-et-immunopathologia-105-articulo-diagnosis-of-drug-allergy-pending-13003971

  Diagnosis of drug allergy a pending problem? […] The diagnosis of drug allergy is a problem that has not yet been fully resolved, constituting a handicap of allergologists that has some similarities with food allergies. […] The major (PPL) and minor determinants (MDM) of penicillin are known, but little is known about the metabolites of other medications. This explains in part why negative diagnostic tests (false negatives) are frequent, whether the tests are carried out in the laboratory or as skin tests. […] The value of skin tests is limited, although they are very useful in some cases. Skin tests, particularly when carried out with antibiotics, often produce non-specific responses that can be either falsely negative or falsely positive (non-specific irritation). […] Among the laboratory tests for immediate type reactions, the only accredited test is the determination of specific IgE against a few medications, such as beta-lactams or insulin.

• #35 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  The value of skin testing depends on the specific drug. Skin tests are very useful in diagnosing immediate hypersensitivity reactions induced by beta-lactams, iodinated radiocontrast media, proton pump inhibitors, high molecular weight heparins, corticosteroids, and platinum compounds. […] Although the LTT has been used for more than three decades to investigate drug sensitization in non-immediate reactions, its usefulness in SJS/TEN is still controversial. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] HLA testing prior to drug administration can be used as a tool to prevent severe hypersensitivity reactions in patients at risk.

• #36 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  In vitro tests have the advantage over in vivo diagnostic tests of being safe. […] There are two categories of in vitro tests commonly used in the diagnosis of immediate DHRs: (1) histamine and tryptase determinations, which are not drug specific and are markers of type I hypersensitivity in general; and (2) identification of drug-specific IgE, and the basophil activation test, which are drug specific and can help to identify or confirm drug causality. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] An increasing number of studies have shown an association between specific HLA alleles and the development of delayed drug hypersensitivity reactions. […] There is currently no diagnostic tool that offers 100% NPV for immediate or delayed hypersensitivity reactions, and any decision to reintroduce a drug or another member of its drug class in the treatment setting should weigh the risk/benefit ratio.

• #37 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  The value of skin testing depends on the specific drug. Skin tests are very useful in diagnosing immediate hypersensitivity reactions induced by beta-lactams, iodinated radiocontrast media, proton pump inhibitors, high molecular weight heparins, corticosteroids, and platinum compounds. […] Although the LTT has been used for more than three decades to investigate drug sensitization in non-immediate reactions, its usefulness in SJS/TEN is still controversial. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] HLA testing prior to drug administration can be used as a tool to prevent severe hypersensitivity reactions in patients at risk.

• #38 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  In vitro tests have the advantage over in vivo diagnostic tests of being safe. […] There are two categories of in vitro tests commonly used in the diagnosis of immediate DHRs: (1) histamine and tryptase determinations, which are not drug specific and are markers of type I hypersensitivity in general; and (2) identification of drug-specific IgE, and the basophil activation test, which are drug specific and can help to identify or confirm drug causality. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] An increasing number of studies have shown an association between specific HLA alleles and the development of delayed drug hypersensitivity reactions. […] There is currently no diagnostic tool that offers 100% NPV for immediate or delayed hypersensitivity reactions, and any decision to reintroduce a drug or another member of its drug class in the treatment setting should weigh the risk/benefit ratio.

• #39 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  In vitro tests have the advantage over in vivo diagnostic tests of being safe. […] There are two categories of in vitro tests commonly used in the diagnosis of immediate DHRs: (1) histamine and tryptase determinations, which are not drug specific and are markers of type I hypersensitivity in general; and (2) identification of drug-specific IgE, and the basophil activation test, which are drug specific and can help to identify or confirm drug causality. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] An increasing number of studies have shown an association between specific HLA alleles and the development of delayed drug hypersensitivity reactions. […] There is currently no diagnostic tool that offers 100% NPV for immediate or delayed hypersensitivity reactions, and any decision to reintroduce a drug or another member of its drug class in the treatment setting should weigh the risk/benefit ratio.

• #40

  https://link.springer.com/article/10.1007/s40521-023-00345-6

  In this review, existing validated in vitro techniques that may support the diagnosis of both immediate and non-immediate DHRs are summarised. […] The evaluation of hypersensitivity reactions to drugs involves three main strategies: accurately reviewing the patients clinical history, conducting diagnostic tests (skin tests and/or in vitro tests) and performing drug challenge tests. […] However, laboratory tests in drug allergy diagnosis have limitations: they confer moderate sensitivity, availability is not guaranteed for all drugs, and some of the techniques are only available in specialised laboratories. […] Maximizing their potential utility, therefore, requires a tailored approach, focused on an appropriate clinical characterization of the reaction. […] The main objectives in the management of a DHR after its treatment and resolution are as follows: to search for the culprit drug in order to instruct future avoidance, when possible and to clarify tolerance to alternative treatments for the patient.

• #41 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  The main caveat when using these algorithms is that they were primarily developed to assess drug causality in type A (on-target) adverse drug reactions, with drug allergies being mostly type B (off-target) reactions and some severe, in which re-exposures are largely contraindicated. […] Although drug challenge is the gold standard technique to confirm or discard a drug allergy, due to safety concerns, it is used when all the available alternative tests (in vivo and in vitro) are negative, considering the patients comorbidities and the necessity and utility of achieving an accurate diagnosis. […] Skin tests (prick and intradermal) and patch testing are useful in vivo tools used for etiologic diagnosis of drug allergy. […] Skin testing is the primary diagnostic tool for identifying patients with IgE- or T cell-mediated reactions to drugs.

• #42 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  Various methods have been proposed to evaluate the causal relationship between an adverse event and the medication taken by the patient. […] Although drug challenge is the gold standard technique to confirm or discard a drug allergy, due to safety concerns, it is used when all the available alternative tests (in vivo and in vitro) are negative, considering the patient’s comorbidities and the necessity and utility of achieving an accurate diagnosis. […] Skin tests (prick and intradermal) and patch testing are useful in vivo tools used for etiologic diagnosis of drug allergy. […] The epicutaneous test (or patch test) is a valuable diagnostic tool to identify the culprit drug after delayed DHRs. […] If in vitro tests and epicutaneous/skin tests are negative, a drug challenge with the suspect agent might be the only way to discard or confirm its imputability.

• #43 Drug Allergy Testing | NEW EL

  https://www.eastlansingallergy.org/general-9-2

  If the diagnosis of a drug allergy is uncertain and your doctor judges that an allergy is unlikely, he or she may recommend a graded drug challenge. […] If you reach the therapeutic dose with no reaction, then your doctor will conclude that you aren’t allergic to the drug. You will be able to take the drug as prescribed. […] If it’s necessary for you to take a drug that has caused an allergic reaction, your doctor may recommend a treatment called drug desensitization.

• #44 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  After looking at your symptoms and test results, a healthcare professional can usually reach one of the following conclusions: You have a drug allergy. You don’t have a drug allergy. You may have a drug allergy with varying degrees of certainty. […] If you have a confirmed drug allergy, a healthcare professional likely would not prescribe the medicine that causes a reaction unless it is necessary. Sometimes if the diagnosis of drug allergy is uncertain or there’s no other treatment your health professional may use one of two strategies to give you the suspect medicine. […] If the diagnosis of a drug allergy is uncertain and a healthcare professional judges that an allergy is unlikely, a graded drug challenge may be an option. […] If it’s necessary for you to take a medicine that has caused an allergic reaction, your care professional may recommend a treatment called drug desensitization.

• #45 Medication Reactions? Discover Drug Allergy Testing Solutions | Labcorp

  https://www.labcorp.com/treatment-areas/allergies/drug

  An allergy to a drug or over-the-counter medication may be difficult to diagnose and relies on gathering a detailed history of all the drugs or medicines you’ve taken in the past. […] The first step to understanding your allergy starts with scheduling an appointment with your primary care provider and asking if blood-based allergen-specific IgE testing can help provide answers. […] A drug allergy blood test is a convenient blood test, appropriate for anyone (age 3 months and older), not affected by prescription or over-the-counter medications. […] Along with a medical exam and detailed medical history, the results of a drug allergy blood test could help your healthcare provider or specialist identify the drug or medicine triggering your allergy symptoms. […] Your primary care provider can help create a personalized allergy action plan that helps you avoid drug-induced allergic reactions. […] 15-25% Adverse drug reactions are common, affecting between 15-25% of patients. […] Penicillin is the most frequent drug allergy, affecting approximately 10 percent of patients.

• #46 Diagnosing and managing drug allergy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5929892/

  Cutaneous manifestations are the most common presentation of allergic drug reactions. […] Diagnosis of drug allergy is largely based on clinical history because diagnostic tests are limited. […] Most patients who are labelled as having penicillin allergy can tolerate penicillins after allergy evaluation. […] Cross-reactivity between cephalosporins and penicillins is rare. […] Maculopapular rashes with amoxicillin are common and not an absolute contraindication for future use. […] The approach to diagnosis begins with the patients medical history, which may identify the etiology of the reaction, identify drug allergy as a possible cause of symptoms and provide details suggesting the possible type of drug-induced allergic reaction. […] The Naranjo Adverse Drug Reaction Probability Scale can be used, based on the patients history, as a validated probability scale to help determine the likelihood that the symptoms described represent an adverse drug reaction.

• #47 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  A thorough exam and appropriate diagnostic tests are essential for an accurate diagnosis. A misdiagnosed penicillin allergy may result in the use of less-appropriate or more-expensive antibiotics. […] Your doctor will conduct a physical examination, ask questions about your symptoms and order additional tests. You may be referred to an allergy specialist (allergist) for these tests. These may include the following. […] A positive result indicates a high likelihood of penicillin allergy. A negative test result usually means you’re not at high risk of an allergy to penicillin. But a negative result is more difficult to interpret because some kinds of drug reactions cannot be detected by skin tests. […] If the diagnosis of a penicillin allergy is uncertain, a graded drug challenge may be recommended.

• #48 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication. […] In a Baltimore, Maryland, STI clinic study, only 7.1% of the patients who reported allergy to penicillin or to another -lactam antibiotic had an objective positive test for penicillin allergy. […] Evaluating a patient who reports a penicillin or another -lactam antibiotic allergy involves three steps: 1) obtaining a thorough medical history, including previous exposures to penicillin or other -lactam antibiotics; 2) performing a skin test evaluation by using the penicillin major and minor determinants; and 3) among those who have a negative penicillin skin test, performing an observed oral challenge with 250 mg amoxicillin before proceeding directly to treatment with the indicated -lactam therapy.

• #49 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  After looking at your symptoms and test results, a healthcare professional can usually reach one of the following conclusions: You have a drug allergy. You don’t have a drug allergy. You may have a drug allergy with varying degrees of certainty. […] If you have a confirmed drug allergy, a healthcare professional likely would not prescribe the medicine that causes a reaction unless it is necessary. Sometimes if the diagnosis of drug allergy is uncertain or there’s no other treatment your health professional may use one of two strategies to give you the suspect medicine. […] If the diagnosis of a drug allergy is uncertain and a healthcare professional judges that an allergy is unlikely, a graded drug challenge may be an option. […] If it’s necessary for you to take a medicine that has caused an allergic reaction, your care professional may recommend a treatment called drug desensitization.

• #50 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  If you are allergic to one type of penicillin, your doctor may recommend a graded challenge with a type of penicillin or cephalosporin that’s less likely because of known chemical properties to cause an allergic reaction. […] During a drug challenge, your doctor provides careful supervision, and supportive care services are available to treat an adverse reaction. […] If there are no other suitable antibiotic treatment options available, your doctor may recommend a treatment called drug desensitization that may enable you to take a course of penicillin to treat an infection. […] You’re carefully monitored during the intervention, and supportive care is available to treat reactions. Desensitization is not always successful, and there is a risk of serious reactions.

• #51 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  The classification of drug allergic reactions is challenging. From the clinical point of view, DHRs are usually classified as immediate or non-immediate (delayed) depending on the time of onset during treatment. […] Accurate diagnosis of specific clinical entities is key for identification of potential culprits. […] The first step in the diagnosis approach to drug allergy is to suspect a hypersensitivity reaction to an administered drug. A precise description of the morphology and chronology of the reaction is mandatory. […] The diagnosis of drug allergic reactions also requires knowledge of the scientific literature, including access to Medline searches to look up a particular compound and a specific hypersensitivity reaction. […] After the carefully taken anamnesis, the allergists will know whether the reaction they are dealing with is a probable immediate or non-immediate drug allergic reaction, its phenotype, and which tools should be used to identify the culprit drug.

• #52 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  In vitro tests have the advantage over in vivo diagnostic tests of being safe. […] There are two categories of in vitro tests commonly used in the diagnosis of immediate DHRs: (1) histamine and tryptase determinations, which are not drug specific and are markers of type I hypersensitivity in general; and (2) identification of drug-specific IgE, and the basophil activation test, which are drug specific and can help to identify or confirm drug causality. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] An increasing number of studies have shown an association between specific HLA alleles and the development of delayed drug hypersensitivity reactions. […] There is currently no diagnostic tool that offers 100% NPV for immediate or delayed hypersensitivity reactions, and any decision to reintroduce a drug or another member of its drug class in the treatment setting should weigh the risk/benefit ratio.

• #53

  https://link.springer.com/article/10.1007/s40521-023-00345-6

  Two types of in vitro tests are available to meet these objectives: those which help characterise the type of reaction during the acute phase and those applied after reaction resolution, to seek the culprit drug. […] An approach that considers the possible mechanism involved in a reaction is necessary to select the best in vitro techniques and to optimise their performance. […] The clinical evaluation of NIDHR can be challenging, especially if systemic symptoms are present, and therefore, a broad differential diagnosis should be considered. […] The main technique available for the diagnosis of NIDHR is a cellular technique, based on lymphocyte proliferation after stimulation with suspected allergens, named lymphocyte transformation test (LTT). […] LTT addresses drug-specific T cell the main cell type orchestrating DHR proliferation.

• #54

  https://link.springer.com/article/10.1007/s40521-023-00345-6

  In general, LTT has a good specificity (63100%) and a low to moderate sensitivity (2589%), although data differ for different drugs and clinical phenotypes. […] Although proliferation is the main read-out method used in LTT, other strategies can be used independently or in combination with proliferation, such as the detection of activation markers with flow cytometry. […] The decision to use them should always involve a careful consideration of clinical symptoms, history and skin testing data available from patients. […] There is still a need for improving sensitivity in most of the techniques and specificity for certain drugs. […] Furthermore, several tests require specialised equipment and trained personnel and thus are not broadly available.

• #55 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  After looking at your symptoms and test results, a healthcare professional can usually reach one of the following conclusions: You have a drug allergy. You don’t have a drug allergy. You may have a drug allergy with varying degrees of certainty. […] If you have a confirmed drug allergy, a healthcare professional likely would not prescribe the medicine that causes a reaction unless it is necessary. Sometimes if the diagnosis of drug allergy is uncertain or there’s no other treatment your health professional may use one of two strategies to give you the suspect medicine. […] If the diagnosis of a drug allergy is uncertain and a healthcare professional judges that an allergy is unlikely, a graded drug challenge may be an option. […] If it’s necessary for you to take a medicine that has caused an allergic reaction, your care professional may recommend a treatment called drug desensitization.

• #56 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  An accurate diagnosis is essential. Research has suggested that drug allergies may be overdiagnosed and that patients may report drug allergies that have never been confirmed. Misdiagnosed drug allergies may result in the use of less appropriate or more-expensive medicines. […] A healthcare professional typically does a physical exam and asks you questions. Details about when symptoms started, the time you took the medicine, and improvement or worsening of symptoms are important clues for helping your health professional make a diagnosis. […] Your health professional may order more tests or refer you to an allergy specialist, called an allergist, for tests. These may include the following. […] A positive result suggests that you may have a drug allergy. […] A negative result isn’t as clear-cut. For some medicines, a negative test result usually means that you’re not allergic to the medicine. For other medicines, a negative result may not completely rule out the possibility of a drug allergy.

• #57 Drug Allergy Testing | NEW EL

  https://www.eastlansingallergy.org/general-9-2

  One of the most reliable tests we have is the test for penicillin allergy. […] Sometimes the allergist will do a drug challenge. A drug challenge is a test where the allergist gives you a small amount of a drug in gradual doses while observing you to watch for a reaction. If you have a true allergy or a suspected allergy to a drug, stop taking the drug. […] A positive result suggests you may have a drug allergy. A negative result isn’t as clear-cut. For some drugs, a negative test result usually means that you’re not allergic to the drug. For other drugs, a negative result may not completely rule out the possibility of a drug allergy. […] While there are blood tests for detecting allergic reactions to a few drugs, these tests aren’t used often because of the relatively limited research on their accuracy.

• #58 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://www.mdpi.com/1422-0067/24/16/12577

  In vitro tests have the advantage over in vivo diagnostic tests of being safe. […] There are two categories of in vitro tests commonly used in the diagnosis of immediate DHRs: (1) histamine and tryptase determinations, which are not drug specific and are markers of type I hypersensitivity in general; and (2) identification of drug-specific IgE, and the basophil activation test, which are drug specific and can help to identify or confirm drug causality. […] The basophil activation test (BAT) is a flow cytometry assay that detects the ability of IgE to activate basophils, which are stimulated due to drug exposure. […] The lymphocyte transformation test (LTT) relies on the ability of drug-specific memory T cells to proliferate upon stimulation with the nominal antigen. […] An increasing number of studies have shown an association between specific HLA alleles and the development of delayed drug hypersensitivity reactions. […] There is currently no diagnostic tool that offers 100% NPV for immediate or delayed hypersensitivity reactions, and any decision to reintroduce a drug or another member of its drug class in the treatment setting should weigh the risk/benefit ratio.

• #59 Accurately diagnosing antibiotic allergies – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/accurately-diagnosing-antibiotic-allergies

  Diagnosing true drug allergy can be challenging and it is important that patients are managed appropriately. […] Drug allergy, as defined by the British Society for Allergy and Clinical Immunology, is an adverse drug reaction with an established immunological mechanism. […] Correct diagnosis can be difficult, but true allergy is more likely if the patient has recognised allergic symptoms (e.g. rash, rash involving hives, wheezing, or swelling of the skin or throat), or has previously experienced a similar reaction to the same agent or another agent in the same class. […] Accurate diagnosis and antimicrobial stewardship practices are therefore key. […] Pharmacists, working as part of the wider multidisciplinary team, are able to effectively manage infections in patients with antibiotic allergies by delabelling their inappropriate allergy status on admission.

• #60 Medication Reactions? Discover Drug Allergy Testing Solutions | Labcorp

  https://www.labcorp.com/treatment-areas/allergies/drug

  An allergy to an over-the-counter medication or prescription drug typically appears as a skin reaction, such as a fever, rash or hives, but a drug allergy can also cause a serious condition called anaphylactic shock. […] Avoid triggering drug-induced symptoms and get answers about the source of an allergic reaction with an allergy blood test. […] Understand the underlying triggers of your patients symptoms and rule in or rule out a drug allergy as the cause. […] Given that an allergy to medication can affect a patients quality of life, potentially lead to delayed treatment, the use of suboptimal alternate medications or even death, its important to accurately diagnose a drug allergy. […] Along with a physical exam, detailed patient history and their use of previous medications, specific IgE blood testing can help evaluate an IgE-mediated allergen sensitization, which may help correctly diagnose a drug allergy.

• #61 Drug allergy | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0289-y

  Diagnosis requires a thorough drug history, including dates of administration, drug formulation, dosage and route of administration, as well as clinical symptoms and their timing and duration in relation to drug exposure; skin testing and graded challenges may also be required. […] The mainstay of treatment for drug allergy is avoidance of the offending drug. […] If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, induction of drug tolerance procedures may be considered to induce temporary tolerance to the drug.

• #62 Editor’s Pick: A Review of Drug Allergies: Diagnosis and Management – European Medical Journal

  https://www.emjreviews.com/allergy-immunology/article/editors-pick-a-review-of-drug-allergies-diagnosis-and-management/

  The most common clinical manifestations of drug allergy are seen on the skin and sometimes mucous membranes. […] The most common cutaneous manifestation is generalised exanthema (as a maculopapular rash), which appears between a few days and 3 weeks after drug exposure, usually starting on the trunk and eventually spreading to the limbs. […] Diagnosis relies on a meticulous history and physical examination. Skin testing, and if warranted graded challenges of allergen, and induction of drug tolerance procedures may be required in some instances. […] The mainstay of treatment for drug allergy is avoidance of the offending drug. […] When available, alternative medications with unrelated chemical structures should be substituted. […] Cross-reactivity among drugs should be taken into consideration when choosing alternative medications. […] If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, procedures of induction of drug tolerance may be considered for producing temporary tolerance to the drug.

• #63 Editor’s Pick: A Review of Drug Allergies: Diagnosis and Management – European Medical Journal

  https://www.emjreviews.com/allergy-immunology/article/editors-pick-a-review-of-drug-allergies-diagnosis-and-management/

  The most common clinical manifestations of drug allergy are seen on the skin and sometimes mucous membranes. […] The most common cutaneous manifestation is generalised exanthema (as a maculopapular rash), which appears between a few days and 3 weeks after drug exposure, usually starting on the trunk and eventually spreading to the limbs. […] Diagnosis relies on a meticulous history and physical examination. Skin testing, and if warranted graded challenges of allergen, and induction of drug tolerance procedures may be required in some instances. […] The mainstay of treatment for drug allergy is avoidance of the offending drug. […] When available, alternative medications with unrelated chemical structures should be substituted. […] Cross-reactivity among drugs should be taken into consideration when choosing alternative medications. […] If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, procedures of induction of drug tolerance may be considered for producing temporary tolerance to the drug.

• #64 Drug allergy | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0289-y

  Diagnosis requires a thorough drug history, including dates of administration, drug formulation, dosage and route of administration, as well as clinical symptoms and their timing and duration in relation to drug exposure; skin testing and graded challenges may also be required. […] The mainstay of treatment for drug allergy is avoidance of the offending drug. […] If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, induction of drug tolerance procedures may be considered to induce temporary tolerance to the drug.

• #65 Drug allergy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/drug-allergy/diagnosis-treatment/drc-20371839

  After looking at your symptoms and test results, a healthcare professional can usually reach one of the following conclusions: You have a drug allergy. You don’t have a drug allergy. You may have a drug allergy with varying degrees of certainty. […] If you have a confirmed drug allergy, a healthcare professional likely would not prescribe the medicine that causes a reaction unless it is necessary. Sometimes if the diagnosis of drug allergy is uncertain or there’s no other treatment your health professional may use one of two strategies to give you the suspect medicine. […] If the diagnosis of a drug allergy is uncertain and a healthcare professional judges that an allergy is unlikely, a graded drug challenge may be an option. […] If it’s necessary for you to take a medicine that has caused an allergic reaction, your care professional may recommend a treatment called drug desensitization.

• #66 Drug Hypersensitivity and Desensitization Center | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/medicine/allergy-clinical-immunology/allergy-drug-hypersensitivity-and-desensitization-center

  The Drug Hypersensitivity and Desensitization Center serves patients with drug allergy, providing them with the opportunity to receive the first line treatments that are essential to their medical care. […] Evaluation and diagnosis of Drug Hypersensitivity. […] A skin test and clinical evaluation shed insight into if a reaction was immunoglobulin-E (IgE) mediated or non-IgE mediated. […] Our program has performed thousands of desensitizations since its inception in 1995, with almost 900 desensitizations now performed on a yearly basis. […] The treatment introduces small increasing doses of drug to the patient in 15-minute intervals until the patient is considered desensitized and the final dose is safely reached. […] Once a patient enters the desensitization program, all subsequent infusions of the allergic drug will be given as desensitizations for as long as needed or until an allergist deems it safe to receive the allergic drug in normal infusion.

• #67 Clinic marks 10th year of diagnosis and treatment of drug allergies – VUMC News

  https://news.vumc.org/2024/09/18/clinic-marks-10th-year-of-diagnosis-and-treatment-of-drug-allergies/

  The clinic, celebrating its 10th year, has seen groundbreaking discoveries in personalized care and diagnosis for allergy, especially delayed drug allergy, and has advanced discoveries in the optimal process to test patients for drug allergies. […] The clinic has pioneered many delabeling and other testing services and paved the way for many other centers in the U.S. and internationally to follow suit, Phillips said. […] Penicillin remains the most frequently reported drug allergy, Stone said. Common reactions evaluated include hives, rash and itching, but severe reactions include anaphylaxis. […] The drug allergy clinic is also investigating what happens in someone who has a true drug allergy. Why did it happen to that individual? Whats different about their genetics and their risk factors? Stone said.

• #68 Drug allergy – Allergy & Anaphylaxis Australia

  https://allergyfacts.org.au/__interest/drug-allergy/

  Many people have experienced side effects to a drug (medication), such as a headache, stomach upset or mild nausea. […] Some people can have an allergic reaction to a drug. […] Although true drug allergies are not common, if you suspect you or someone you know may have a drug allergy, it is important to be diagnosed correctly so that you can be given appropriate treatment when you need it. […] If you think you have an allergy to a drug, speak to your GP. […] If it is uncertain whether you have an allergy to a drug, your GP may refer you to an allergy specialist for skin prick tests or blood tests. […] You may need to be tested in a hospital allergy clinic to confirm whether or not you have a drug allergy. […] If you experience signs of a severe reaction after taking a medication, call triple zero (000) for an ambulance. […] If you are confirmed to have a true drug allergy, you should avoid taking that drug. […] ensure the drug allergy is clearly documented in your medical records, including with your GP, hospital, pharmacy and My Health Record.

• #69 Adverse Drug Reactions: Types and Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1101/p1781.html

  Once the diagnosis has been established, appropriate documentation should be included in the medical record specifying the causative drug and the nature of the adverse effect. Immune-mediated drug hypersensitivity reactions typically pose a predictable, more serious health risk with re-exposure to a drug. Nonimmune drug reactions tend to be less severe and less reproducible.

• #70 Drug Allergy | Mount Sinai – New York

  https://www.mountsinai.org/care/allergy-immunology/services/drug-allergy

  Drug allergies are a bad physical reaction to a type of medication. […] A drug allergy may cause symptoms that are relatively minor, like hives or other rashes that can be treated, but it also can lead to anaphylaxis, a potentially life-threatening allergic reaction. Therefore, drug allergies must be known and avoided. […] However, the diagnosis of a drug allergy can be frustrating and confusing. You can have an allergic reaction while taking several drugs at the same time and not know which one is the culprit. […] It is important to confirm any suspicion of a drug allergy so the best drugs for a particular condition can be prescribed for you. […] The key to managing a suspected drug allergy is to evaluate whether or not the allergy may be real, or a misdiagnosed intolerance or side effect. […] In some cases, evaluating a suspected drug allergy may involve taking a specifically prescribed amount of the drug under careful observation by the medical team. […] Your doctors also will work to ensure that your documented medical record of drug allergies is up to date and accurate.

• #71 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  Drug hypersensitivity reactions are a serious concern in clinical practice because they can be severe and result in lifelong sequelae. An accurate diagnosis and identification of the culprit drug is essential to prevent future reactions as well as for the identification of safe treatment alternatives. Nonetheless, the diagnosis can be challenging. In vivo and in vitro tests can be helpful, although none are conclusive; therefore, the tests are not usually performed in isolation but as part of a diagnostic algorithm. In addition, some in vitro tests are only available in research laboratories, and standardization has not been fully accomplished. Collaborating research is needed to improve drug hypersensitivity reaction diagnosis. In this review, we update the current available in vivo and in vitro tools with their pros and cons and propose an algorithm to integrate them into clinical practice.

• #72 Drug allergy | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0289-y

  Drug allergy encompasses a spectrum of immunologically-mediated hypersensitivity reactions with varying mechanisms and clinical presentations. […] Given the myriad of symptoms associated with the condition, diagnosis is often challenging. Therefore, referral to an allergist experienced in the identification, diagnosis and management of drug allergy is recommended if a drug-induced allergic reaction is suspected. Diagnosis relies on a careful history and physical examination and, in some instances, skin testing and graded challenges. […] The diagnosis of drug allergy requires a thorough history and the identification of physical findings and symptoms that are compatible with the characteristics and timing of drug-induced allergic reactions. […] Therefore, if drug allergy is suspected, evaluation by an allergist experienced in these diagnostic procedures is recommended.

• #73 Drug allergy | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0289-y

  Drug allergy encompasses a spectrum of immunologically-mediated hypersensitivity reactions with varying mechanisms and clinical presentations. […] Given the myriad of symptoms associated with the condition, diagnosis is often challenging. Therefore, referral to an allergist experienced in the identification, diagnosis and management of drug allergy is recommended if a drug-induced allergic reaction is suspected. Diagnosis relies on a careful history and physical examination and, in some instances, skin testing and graded challenges. […] The diagnosis of drug allergy requires a thorough history and the identification of physical findings and symptoms that are compatible with the characteristics and timing of drug-induced allergic reactions. […] Therefore, if drug allergy is suspected, evaluation by an allergist experienced in these diagnostic procedures is recommended.

• #74 Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10454098/

  Drug hypersensitivity reactions are a serious concern in clinical practice because they can be severe and result in lifelong sequelae. An accurate diagnosis and identification of the culprit drug is essential to prevent future reactions as well as for the identification of safe treatment alternatives. Nonetheless, the diagnosis can be challenging. In vivo and in vitro tests can be helpful, although none are conclusive; therefore, the tests are not usually performed in isolation but as part of a diagnostic algorithm. In addition, some in vitro tests are only available in research laboratories, and standardization has not been fully accomplished. Collaborating research is needed to improve drug hypersensitivity reaction diagnosis. In this review, we update the current available in vivo and in vitro tools with their pros and cons and propose an algorithm to integrate them into clinical practice.

• #75

  https://www.healio.com/news/allergy-asthma/20230807/qa-drug-allergy-diagnosis-project-could-touch-every-single-specialty

  Drug allergy diagnosis could become more precise, cutting down on mislabeled allergies and needless drug avoidance, as a result of upcoming work comparing different types of drug hypersensitivity reactions. […] The study aims to investigate the mechanisms underlying non-IgE-mediated immediate drug hypersensitivity reactions (IDHSRs), specifically focusing on vancomycin as a prototype drug. […] By addressing these aims simultaneously, the study aims to advance the understanding of non-IgE IDHSR mechanisms, contribute to developing specific diagnostics and enhance clinical care for patients experiencing IDHSRs to vancomycin and potentially other MRGPRX2 ligands. […] The investigation of this topic was prompted by the significant impact of misclassifying IDHSRs, which can result in detrimental consequences such as unnecessary drug avoidance and reliance on less effective and costlier alternatives.

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