Treatment Figure 1. Algorithm for Disease Management of Drug Allergy
Patient develops a possible ADR
physical examination and clinical tests support an ADR
Review of medical history, the patient's records,
YES
allergic reaction suspected?
induced Drug- NO YES
confirmatory tests available?
appropriate Are NO YES
Are tests positive?
YES
Diagnosis of drug allergic reaction confirmed
high negative predictive value?
test have Does NO 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
NO
Consider other possibilities
effect, drug interaction) or due to idiosyncrasy, intolerance or pseudoallergic effects of the drug
predictable (eg, toxicity, side The adverse reaction is Future management and prevention
of nonimmune ADR > Modify dose (for toxicity, side effect or drug interactions)
> Alternative drug > Consider graded challenges > Consider prophylactic regimens
> Patient education
before administration (if shown to be effective)
> 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
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