Detection of patients with multiple drug allergy syndrome by elective tolerance tests.
BACKGROUND
Multiple drug allergy syndrome (MDAS) caused by antibiotics is frequently observed in allergy departments; however, risk factors for such a condition as well as the means to detect patients prone to MDAS are poorly defined.


OBJECTIVE
The identification of patients prone to MDAS and the detection of risk factors for multiple antibiotic sensitivity.


METHODS
Two hundred fifty-three elective oral challenges with alternative antimicrobial drugs were performed in 120 patients with histories of recent allergic reactions to antibiotics.


RESULTS
Twenty-three (19%) subjects reacted to at least one antibiotic class. All reactions were mild and easily controlled by conventional therapy. Female sex, history of multiple antibiotic reactions, and reactions to nonsteroidal antinflammatory drugs were the main risk factors for reactions to alternative antibiotics. To date, no patient has reported immediate adverse reactions to drugs negative on oral challenge tests but one had urticaria/angioedema on the fifth day of full dose treatment with ofloxacin.


CONCLUSIONS
Elective oral challenges with alternative antibiotics are a sensitive, specific, and safe means to detect patients with MDAS, thus sparing them more severe adverse reactions caused by full dose therapies. The recommendation to perform oral challenge tests with antibiotics just before their therapeutic use seems unnecessary and should be reconsidered.
Asero
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Ambulatorio di Allergologia, Ospedale Caduti Bollatesi, Milan, Italy.
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000799:Angioedema / Q000139:chemically induced; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D018432:Drug Resistance, Multiple / Q000276:immunology; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000009:adverse effects; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D018777:Multiple Chemical Sensitivity / Q000175:diagnosis*; D012189:Retrospective Studies; D014581:Urticaria / Q000139:chemically induced
D000900:Anti-Bacterial Agents