title: Practical Management of Patients with a History of Immediate Hypersensitivity to Common non-Beta-Lactam Drugs.
abstract: Immediate hypersensitivity reactions to medications are among the most feared adverse drug reactions, because of their close association with anaphylaxis. This review discusses a practical management approach for patients with a history of an immediate hypersensitivity to a non-beta-lactam medication, where reexposure to the implicated, or similar, medication is clinically necessary. Mechanisms associated with severe immediate hypersensitivity reactions include IgE-mediated mast cell activation, complement-mediated mast cell activation, and direct mast cell activation. Immediate hypersensitivity reactions may also be mediated by vasodilators, other pharmacologic mechanisms, or be secondary to underlying patient-specific biochemical abnormalities such as endocrine tumors or chronic spontaneous urticaria. The key features in the reaction history and the biochemistry of the implicated medication are discussed. Most individuals with a history of immediate hypersensitivity to a medication, who require reuse of that drug, can be safely retreated with a therapeutic course of the implicated drug after a full-dose challenge, graded challenge, or desensitization, with or without premedication and/or any preliminary diagnostic testing, depending on the specific situation.
authors.affiliation: Kaiser Permanente, Department of Allergy, 7060 Clairemont Mesa Blvd, San Diego, CA, 92111, USA. eric.m.macy@kp.org.
authors.forename: Eric
authors.initials: E
authors.lastname: Macy
mesh_terms: D003888:Desensitization, Immunologic / Q000379:methods*; D019468:Disease Management; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D006801:Humans; D047090:beta-Lactams / Q000009:adverse effects*
chemical_list: D047090:beta-Lactams
keywords: Adverse drug reaction; Allergy; Challenge; Complement; Desensitization; Graded challenge; IgE; Immediate hypersensitivity; Intolerance; Mast cell; Nanoparticle; Skin test