Approach to a Patient with an Antibiotic Allergy

The accurate diagnosis of drug allergy is important not only to prevent serious reactions secondary to further exposure but also to avoid the unnecessary restriction of a drug to which the patient may not truly be allergic.

The clinical history is integral in evaluating the likelihood of a drug allergy, because only a small percentage of patients with a reported reaction have a history compatible with actual hypersensitivity. Even in the presence of a consistent history, the proportion of true reactors is low.

Key historical features to seek out include a detailed description of the nature and timing of the reaction, as well as concomitant ingestion of other medications. In addition, taking a thorough medical history for underlying risk factors (e.g., viral infections, prior drug reactions, atopy) is crucial for evaluating antibiotic allergy.

Information to be Obtained When Taking a History ofAntibiotic Allergy

Concerns regarding the reaction include the following:

  1. Timing of the reaction in relation to drug administration

  2. Symptoms and evolution of the reaction

  3. Description of cutaneous symptoms (e.g., maculopapular, urticarial, bullous)

  4. Involvement of mucosal surfaces or internal organs

  5. Treatment administered, response, and duration of reaction

  6. History of prior exposure to the implicated agent

  7. Other medications ingested at the time of the reaction

  8. Was the medication or similar medications taken (and tolerated) thereafter?

  9. Are there potential confounders (e.g., underlying viral or bacterial infections)?

  10. History of other drug reactions and allergies (many patients with multiple drug intolerance syndrome do not have true drug allergies)

  11. Has the patient experienced recurrent, similar reactions without known exposures (e.g., chronic urticaria)?

  12. The likelihood of future need of the medication

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