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TOPICS
Overview
Allergic bronchopulmonary aspergilllosis (ABPA)
Anaphylaxis - Updated
Asthma
Asthma Diagnosis
Environmental diagnosis
and management
Asthma Treatment:
Immunotherapy
Asthma Treatment:
Preventing Morbidity
- Updated
Asthma Treatment:
Preventing Mortality

- Updated
Asthma Treatment:
Adherence
Occupational Asthma
Conjunctivitis
Cough
Dermatitis
Atopic - Updated
Contact
Drug Allergy - Updated
Food Allergy - Updated
Hypersensitivity Pneumonitis
Insect Hypersensitivity
Occupational Diseases
Primary Immune Deficiency - Updated
Rhinitis/Rhinosinusitis
Rhinitis - Updated
Sinusitis
Urticaria/Angioedema - Updated
How the Allergist/Immunologist Can Help:
Consultation and Referral Guidelines Citing the Evidence

Disease Group: Drug Allergy
  1. Patients with a history of penicillin allergy who have a significant probability of requiring future antibiotic therapy.
    [Rationale]
  2. Patients with a history of penicillin allergy who have an infection with no effective alternative therapeutic options, except for a penicillin class antibiotic.
    [Rationale]
  3. Patients with histories of multiple drug allergy/intolerance
    [Rationale]
  4. Patients who may be allergic to protein based bio-therapeutics and require use of these materials
    [Rationale]
  5. Patients with histories of adverse reactions to NSAID who require aspirin or other NSAID
    [Rationale]
  6. Patients who require chemotherapy medication for cancer or other severe conditions and have experienced a prior hypersensitivity reaction to those medications.
    [Rationale]
  7. Patients with a history of possible allergic reactions to local anesthetics.
    [Rationale]
  8. HIV-infected patients with a history of adverse reactions to trimethoprim-sulfamethoxazole (TM-S) who need this therapy.
    [Rationale]





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The vast majority of patients with a history of penicillin allergy can safely use penicillins if an allergy evaluation, often including a penicillin skin test, is performed. 1

History alone is inadequate to rule out IgE mediated allergy to penicillin. 2

Penicillin skin testing in advance of need does not cause significant re-sensitization. 3-6

Patients who are shown not to be allergic to penicillin may be able to use more appropriate and potentially less toxic and/or expensive antibiotics. 7
Diagnostic

Indirect outcome (needed penicillin treatment)
Skin tests may be negative in such patients, who can then safely receive penicillin. 4 However, at the present time, an important penicillin skin test reagent is temporarily commercially unavailable. Antibiotic desensitization in skin test positive patients renders them transiently tolerant and induces negative skin test, indicating blocking of mast cell/IgE activation events. 8-11
Indirect outcome (needed penicillin treatment)
Allergist/immunologists provide a comprehensive plan to evaluate the historical adverse drug reactions and provide suggestions on future therapies to minimize risks.12-15
Diagnostic

Indirect outcome (treatment with needed medications)
Allergist/immunologists perform skin testing using appropriate concentrations and techniques to determine current sensitivity.12, 16-18

Insulin desensitization allows for continued insulin therapy in patients with prior systemic reactions.19, 20
Diagnostic

Indirect outcome (treatment with needed biotherapeutics)
Allergist/immunologists accurately diagnose ASA/NSAID sensitivity through challenge testing.21

Allergist/immunologists perform ASA desensitization in patients with documented ASA sensitivity who require ASA for other medical conditions.10, 21

Desensitization in patients with ASA exacerbated respiratory disease may improve the control of both upper and lower respiratory disease in these patients.10, 21, 22
Diagnostic

Indirect outcome (needed NSAID treatment)

Indirect outcome (improved respiratory symptoms)
Desensitization allows for transient tolerance to chemotherapy medications when there is no alternative treatment.23-25
Indirect outcome (needed chemotherapy)
Allergist/immunologists are able to perform skin testing and graded challenge to find a safe local anesthetic for future use. Virtually all patients with histories of reactions to local anesthetics can subsequently tolerate the same or an alternate agent.26-28
Indirect outcome (needed local anesthetic treatment)
Graded TM-S challenges can identify patients who are not currently sensitive to the drug and allow patients with reactions during challenge to subsequently tolerate the drug and safely continue therapy. 29-35
Diagnostic

Indirect outcome (needed TM-S therapy)