title: Practical Management of Antibiotic Hypersensitivity in 2017.
abstract: Antibiotics are the most common class of medications that individuals report allergy or intolerance to. Adverse reactions are reported at a predictable rate with all antibiotic use that vary by antibiotic. Antibiotic allergy incidence rates are sex dependent, higher in females than in males. Most of these events are not reproducible or immunologically mediated. Antibiotic allergy prevalence increases with increasing age and is more common in hospitalized populations and in populations that use more antibiotics. Determining potential mechanisms for the observed symptoms of the adverse reactions is the starting point for effective management of antibiotic hypersensitivity. Skin testing and direct challenges are the primary tools used to determine acute tolerance in 2017. Commercially available in vitro testing is not currently clinically useful in determining antibiotic hypersensitivity, with rare exceptions. Desensitization can be used when acute-onset immunologically mediated hypersensitivity is confirmed to safely administer a needed antibiotic. Desensitization is not possible when clinically significant T-cell-mediated delayed-type hypersensitivity is present. Effective management of antibiotic allergy is an important part of a comprehensive antibiotic stewardship program.
authors.affiliation: Department of Allergy, Kaiser Permanente San Diego Medical Center, San Diego, Calif. Electronic address: eric.m.macy@kp.org.
authors.forename: Eric
authors.initials: E
authors.lastname: Macy
authors.affiliation: Allergy Unit, Presidio Columbus, Catholic University of Sacred Heart, Rome, Italy; Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Oasi Maria S.S., Troina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Romano
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Khan
mesh_terms: D000367:Age Factors; D000485:Allergens / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D015995:Prevalence; D012737:Sex Factors; D012882:Skin Tests; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D000485:Allergens; D000900:Anti-Bacterial Agents
keywords: Allergy; Antibiotic; Challenge; Desensitization; Hypersensitivity; Management; Skin test; intolerance