Diagnosis and Assessment Aspirin
ÎAspirin and nonsteroidal anti-inflammatory drugs are the second most common cause of drug-induced anaphylaxis. (C)
ÎAnaphylactic reactions to aspirin and other nonsteroidal anti- inflammatory drugs appear to be medication specific, but respiratory reactions are class specific. (D)
Beta-Lactams
ÎBeta-lactam antibiotics are the most common cause of drug-induced anaphylaxis. (C)
ÎPenicillin spontaneously degrades to major and minor antigenic determinants, both of which should be included in skin testing for penicillin hypersensitivity. (B)
ÎThe negative predictive value of penicillin skin testing with both major and minor determinants (for immediate-type reactions) is between 97% and 99% (depending on the reagents used), and the positive predictive value is at least 50%. (B)
ÎThe degree of cross-reactivity between penicillin and cephalosporins or carbapenems appears to be low. (C)
ÎPatients with a history of penicillin allergy who have negative penicillin skin test responses can safely receive cephalosporins. (B)
ÎPatients who need to receive cephalosporins and who have a history of penicillin allergy and positive penicillin skin test responses can receive
> an alternate (non-beta lactam) antibiotic; > a cephalosporin through graded challenge; or > a cephalosporin through rapid desensitization. (C)
ÎAztreonam does not cross-react with other beta lactams, except ceftazidime, with which it shares a common R-group side chain. (B)
ÎDiagnosis of IgE-mediated reactions to non-beta lactam antibiotics is limited by a lack of knowledge of the relevant allergenic determinants and/or metabolites. (C)
Omalizumab
ÎAnaphylactic reactions to omalizumab have occurred, and post- marketing data indicate that there is an incidence of approximately 0.2% in treated patients. These reactions have been unusual in that they can be delayed in onset and progressive. (C)
ÎBased on the fact that anaphylactic reactions to omalizumab can be delayed, an observation period of two hours for the first three injections, and 30 minutes thereafter for subsequent injections is indicated. (D)
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