Treatment Figure 1. Algorithm for Disease Management of Drug Allergy
Patient develops a possible ADR
Review of medical history, the patient's records,
physical examination and clinical tests support an ADR
YES Drug- induced
allergic reaction suspected?
YES Are appropriate
confirmatory tests available?
YES Does
Are tests positive?
YES
Diagnosis of drug allergic reaction confirmed
test have
high negative predictive value?
YES
Patient not allergic to this drug
Patient may be allergic (despite negative drug- specific or nonspecific confirmatory tests)
Management and prevention of drug allergic reactions > Anaphylactic reactions require prompt emergency treatment > Avoid drug if possible > Consider induction of tolerance procedure or graded challenge before administration
> Consider prophylactic regimen before administration (if shown to be effective) > Future prudent use of drugs > Future use of drug causing nonanaphylactic, life-threatening reaction (eg, SJS, Churg-Strauss) contraindicated > Patient education
7 NO NO NO NO
Consider other possibilities
The adverse reaction is predictable (eg, toxicity, side
effect, drug interaction) or due to idiosyncrasy, intolerance or pseudoallergic effects of the drug
Future management and prevention
of nonimmune ADR > Modify dose (for toxicity, side effect or drug interactions)
> Alternative drug > Consider graded challenges > Consider prophylactic regimens before administration (if shown to be effective)
> Patient education
