Β-lactam allergy - Revision history

Aidan: /* Allergy History */

2025-05-23T14:55:12Z

Allergy History

← Older revision		Revision as of 14:55, 23 May 2025
Line 338:		Line 338:
	==== Allergy History ====		==== Allergy History ====

			* Risk assessment:
	* Intolerance: isolated GI upset, chills, headache, or fatigue		** '''Intolerance''': isolated GI upset, chills, headache, or fatigue
	* Low-risk history: family history, itching, unknown and remote (>10 years ago), allergy on record but patient denies		** '''Low-risk history''': family history, itching, unknown and remote (>10 years ago), allergy on record but patient denies
	* Moderate-risk: [[anaphylaxis]], [[angioedema]] or swelling, bronchospasm, cough, nasal symptoms, arrhythmia, throat tightness, hypotension, flushing/redness, dyspnea, rash, [[syncope]], wheeze, dizziness/lightheadedness		** '''Moderate-risk''': [[anaphylaxis]], [[angioedema]] or swelling, bronchospasm, cough, nasal symptoms, arrhythmia, throat tightness, hypotension, flushing/redness, dyspnea, rash, [[syncope]], wheeze, dizziness/lightheadedness
	* High-risk history: [[Stevens-Johnson syndrome]], [[serum sickness]], [[thrombocytopenia]], fever, organ injury (liver or kidney), erythema multiforme, dystonia, anemia, acute ~~generalized~~ exanthematous ~~rash~~ ~~with pustules~~, [[~~DRESS~~]]		** '''High-risk history''': [[Stevens-Johnson syndrome]], [[serum sickness]], [[thrombocytopenia]], fever, organ injury (liver or kidney), [[erythema multiforme]], dystonia, anemia, [[acute generalised exanthematous pustulosis]] (AGEP), [[drug reaction with eosinophilia and systemic symptoms]] (DRESS)
	* Also assess age at time of reaction, time of onset relative to dose, any treatments received, and any other β-lactams that have been used in the past		* Also assess age at time of reaction, time of onset relative to dose, any treatments received, and any other β-lactams that have been used in the past
	* No challenges or testing should be done for patients with a history of penicillin-associated blistering rash, hemolytic anemia, nephritis, [[hepatitis]], fever, or joint pains		* No challenges or testing should be done for patients with a history of penicillin-associated blistering rash, hemolytic anemia, nephritis, [[hepatitis]], fever, or joint pains

Aidan at 17:47, 19 September 2024

2024-09-19T17:47:22Z

← Older revision		Revision as of 17:47, 19 September 2024
Line 334:		Line 334:
	=== Massachusetts General Hospital Algorithm (2019) ===		=== Massachusetts General Hospital Algorithm (2019) ===

			* Developed at MGH[[CiteRef::wolfson2019ac]][[CiteRef::shenoy2019ev]]
	* Developed at MGH[[CiteRef::wolfson2019ac]]<ref>Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. ''JAMA.'' 2019;321(2):188–199. doi:[https://doi.org/10.1001/jama.2018.19283 10.1001/jama.2018.19283]</ref>

	==== Allergy History ====		==== Allergy History ====

Aidan at 22:15, 2 October 2022

2022-10-02T22:15:50Z

Show changes

Aidan at 15:11, 8 July 2022

2022-07-08T15:11:15Z

← Older revision		Revision as of 15:11, 8 July 2022
Line 341:		Line 341:
	* Includes serum sickness, [[Stevens-Johnson syndrome]], [[toxic epidermal necrolysis]], [[acute interstitial nephritis]], [[drug reaction with eosinophilia and systemic symptoms]], [[hemolytic anemia]], and [[drug fever]]		* Includes serum sickness, [[Stevens-Johnson syndrome]], [[toxic epidermal necrolysis]], [[acute interstitial nephritis]], [[drug reaction with eosinophilia and systemic symptoms]], [[hemolytic anemia]], and [[drug fever]]
	* Avoid all penicillins, cephalosporins, and carbapenems		* Avoid all penicillins, cephalosporins, and carbapenems

			=== Test Dose Procedure ===

			* 10% of the standard dose is given and they are monitored for an hour
			* If no reaction is observed in 1 hour, a full dose is given and they are monitored for another hour

	==Further Reading==		==Further Reading==

Aidan: /* Management */

2021-09-21T19:44:36Z

Management

← Older revision		Revision as of 19:44, 21 September 2021
Line 319:		Line 319:
	\|}		\|}

			=== Massachusetts General Hospital Algorithm (2019) ===
	* For those with penicillin allergy

	** 1st gen cephalosporins: cross-reactavoid cephalexin and cefaclor if ampicillin allergic
			* Developed at MGH[[CiteRef::wolfson2019ac]]
	** 2nd gen cephalosporins:

			==== Mild Reaction ====

			* Includes minor rash (not hives), [[maculopapular rash]] (mild type 4 reaction), allergy that is listed but denied by the patient, or an unknown reaction without mucosal involvement, skin desquamation, organ involvement, or need for medical evaluation
			* Okay to use [[cephalosporins]] and [[carbapenems]]
			* Can use penicillin by test dose procedure

			==== Type 1 Reaction ====

			* Includes [[anaphylaxis]], [[angioedema]], [[wheezing]], [[laryngeal edema]], [[hypotension]], [[hives]], and [[urticaria]]
			* Also use for unknown reaction without further details
			* Okay to use 3rd generation or higher [[cephalosporin]] by a test dose procedure
			* Alternatively, can use [[aztreonam]] or [[carbapenems]]
			* Alternatively, can get skin testing if a penicillin or early-generation cephalosporin is preferred

			==== Type 2, 3, or 4 Reaction ====

			* Includes serum sickness, [[Stevens-Johnson syndrome]], [[toxic epidermal necrolysis]], [[acute interstitial nephritis]], [[drug reaction with eosinophilia and systemic symptoms]], [[hemolytic anemia]], and [[drug fever]]
			* Avoid all penicillins, cephalosporins, and carbapenems

	==Further Reading==		==Further Reading==

Aidan: /* Penicillin Allergy */

2021-09-21T13:20:33Z

Penicillin Allergy

← Older revision		Revision as of 13:20, 21 September 2021
Line 300:		Line 300:
	\|Cephalosporin, 2nd generation		\|Cephalosporin, 2nd generation
	\|2%		\|2%
	\|Avoid cefoxitin in penicillin allergy. Avoid cefadroxil and cefprozil in amoxicillin allergy).		\|Avoid cefoxitin in penicillin allergy. Avoid cefadroxil and cefprozil in amoxicillin allergy.
	\|-		\|-
	\|Cephalosporin, 3rd generation		\|Cephalosporin, 3rd generation

Aidan at 17:56, 11 February 2021

2021-02-11T17:56:45Z

@@ Line 266: / Line 266: @@
 |}
-===R1 Side Chains (C6 and C7)===
+====R1 Side Chains (C6 and C7)====
 *'''Group 1:''' [[penicillin]], [[cephalothin]], [[cefoxitin]]; similar to [[ticarcillin]]
@@ Line 273: / Line 273: @@
 *[[Ceftazidime]] and [[aztreonam]]; similar to group 3
-===R2 Side Chains (C3)===
+====R2 Side Chains (C3)====
 *'''Group 1:''' [[cefadroxil]], [[cephalexin]]
@@ Line 282: / Line 282: @@
 *'''Group 6:''' [[cefixime]]
 *'''Group 7:''' [[ceftazidime]]
 ==Further Reading==

Aidan: /* R1 Side Chains (C6 and C7) */

2020-09-16T14:56:35Z

R1 Side Chains (C6 and C7)

← Older revision		Revision as of 14:56, 16 September 2020
Line 18:		Line 18:

	*The following applies to '''immediate, IgE-mediated''' hypersensitivity reactions		*The following applies to '''immediate, IgE-mediated''' hypersensitivity reactions
	*Cross-reactivity ~~between~~ [[penicillins~~]] and [[cephalosporins~~]] is mediated by homology of the R1 side ~~chains,~~ referring to the C6 side chain in ~~[[penicillins]] or~~ the C7 ~~side~~ ~~chain in [[cephalosporins]]~~		*Cross-reactivity within [[penicillins]] is mediated by homology of the R1 side chain (referring to the C6 side chain) and by the β-lactam ring itself
	*Cross-reactivity ~~within~~ [[cephalosporins]] is mediated ~~both~~ by homology of the R1 side chains ~~and~~ ~~also~~ R2 side ~~chains,~~ ~~referring~~ to the C3 side chain		*Cross-reactivity between [[penicillins]] and [[cephalosporins]] is mediated by homology of the R1 side chains (referring to the C6 side chain in [[penicillins]] or the C7 side chain in [[cephalosporins]])
			*Cross-reactivity within [[cephalosporins]] is mediated both by homology of the R1 side chains and also R2 side chains (referring to the C3 side chain)
	*There is very low (~2%) cross-reactivity between penicillin allergy and [[carbapenems]][[CiteRef::kula2014a]]		*There is very low (~2%) cross-reactivity between penicillin allergy and [[carbapenems]][[CiteRef::kula2014a]]

Aidan: /* Cross-Reactivity */

2020-09-16T14:51:47Z

Cross-Reactivity

@@ Line 1: / Line 1: @@
 {{DISPLAYTITLE:β-lactam allergy}}
 ==Cross-Reactivity==
 *Cross-reactivity between [[penicillins]] and [[cephalosporins]] is mediated by homology of the R1 side chains, referring to the C6 side chain in [[penicillins]] or the C7 side chain in [[cephalosporins]]
 *Cross-reactivity within [[cephalosporins]] is mediated both by homology of the R1 side chains and also R2 side chains, referring to the C3 side chain
 {| class="wikitable"
@@ Line 265: / Line 281: @@
 *'''Group 6:''' [[cefixime]]
 *'''Group 7:''' [[ceftazidime]]
 ==Further Reading==

Aidan: /* Further Reading */

2020-09-16T14:37:11Z

← Older revision		Revision as of 14:37, 16 September 2020
Line 282:		Line 282:
	==Further Reading==		==Further Reading==

	*~~Zagursky RJ and Pichichero ME.~~ Cross-reactivity in β-Lactam Allergy. ''J Allergy Clin Immunol Pract''. 2018;6(1):72-81.e1. doi: [https://doi.org/10.1016/j.jaip.2017.08.027 10.1016/j.jaip.2017.08.027]		*Cross-reactivity in β-Lactam Allergy. ''J Allergy Clin Immunol Pract''. 2018;6(1):72-81.e1. doi: [https://doi.org/10.1016/j.jaip.2017.08.027 10.1016/j.jaip.2017.08.027]
			*Cross-Reactivity to Cephalosporins and Carbapenems in Penicillin-Allergic Patients: Two Systematic Reviews and Meta-Analyses. ''J Allergy Clin Immunol Pract''. 2019;7(8):2722-2738.e5. doi: [https://doi.org/10.1016/j.jaip.2019.05.038 10.1016/j.jaip.2019.05.038]

	[[Category:Antibiotics]]		[[Category:Antibiotics]]