Antibiotci Allergy Flashcards
Hypersensitivity reaction types
D
Type 1
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
D
Type 2
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
D
Type 3
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
Type 4
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
E
Drug antigen bind and cross link IgE on allergic cell which results in degranulation
S
Drug antigen specific igG bind antigen on the cell surface or matrix and activated phagocytosis cell
D
Drug antigen specific IgG bind to soluble antigen forming complexes that activate complement and phagocytic cell
D
Drug antigen specific t lymphocyte receptor bind to drug antigen and activate t lymphocyte with effector cell including macrophage, eosinophils and or cytotoxic t lymphocyte
D
Minuet to hours
D
Days to week
D
Combo testing
D
Complement level
D
Prolonged drug challenge
D
Type A:
D
Type B:
E
pharmacologically predictable, dose-dependent, non-
immune-mediated, and less influenced by genetic factors
D
pharmacologically unpredictable, non-dose-dependent and
often immune-mediate
E
being caused by mechanisms of
action other than the intended primary pharmacologic mechanism of action of the drug.
X
The off-target can be:
E
Most delayed reactions begin
after six hours and typically after days of treatment
D
Directly attributable to vasoactive mediators released by mast cells
and basophils
D
Attributable to anti-body
mediated cell destruction
F
Due to inflammation in response
to AG-AB complex
C
Activation of T-cells
E
Urticarial rash
D
Pruritus, flushing
W
Angiodema of face, extremities or
laryngeal tissue
E
Wheezing, Bronchospasm, rhinitis
S
• GI symptoms, hypotension
W
Anaphylaxis
E
Hemolytic anemia
D
Thrombocytopenia
E
Neutropenia
R
Serum sickness
D
Vasculitis
D
Arthus reaction
D
Contact dermatitis
E
Maculopapular (including
morbilliform) eruptions
D
SDRIFE — “Symmetrical drug-
related intertriginous and flexural
exanthem”
D
Acute generalized exanthematous
pustulosis — AGEP
E
Drug fever
D
Stevens-Johnson syndrome/toxic
epidermal necrolysis (SJS,TEN)
D
Drug-induced hypersensitivity
syndrome — DiHS, also called
DRESS
D
The signs and symptoms of most pseudoallergic reactions are similar
to IgE-mediated (immediate) allergic reactions
W
Both can involve urticaria, angioedema, or anaphylaxis due to mast cell
degranulation.
E
Anaphylaxis is likely when any one of the three criteria is fulfilled
D
Evaluation of patients with penicillin allergy
C
Allergy history:
W
Skin testing for immediate reaction
E
Is a bioassay that detects the presence of allergen-specific IgE on the surface of a patient’s cutaneous
mast cells.
W
Skin testing
Mechanism
Indication
Safety
Contraindicated
D
Mast cell activation results in a positive skin test, which is a transient “wheal-and-flare” reaction
within 15 to 20 minutes from application of the allergen.
W
Most rapid, sensitive, and cost-effective testing modality for identifying penicillin-sensitized patients
W
High risk for an anaphylactic reaction to testing,
D
Have experienced a recent anaphylactic event,
C
Taking medications that may interfere with the treatment of anaphylaxis, or
F
Have certain skin conditions.
E
Skin testing
Procedure
D
Two methods of skin testing for IgE-mediated disorders:
C
performed following negative prick/puncture tests and are approximately 100- to
F
should be performed first, and if negative, intradermal tests should
D
The minimal reagents required are:
E
Positive and negative controls,
D
The major determinant (penicilloyl-polylysine [PPL]) and
R
The minor determinant penicillin G.
F
Following negative skin test results, the absence of allergy should be confirmed with a ……..
R
Do not perform any pencillin allergy testing if there is history of pencilllin associated
D
Blistering rash
D
Nephritis
D
Hepatitis
E
Fever
F
Joint pain
S
The reaction was cutaneous
S
The reaction had feature of IgE / immediate
S
The patient unstable or compromised hemodynamics or respiratory status or pregnancy with low risk allergy history
D
Skin testing: Delayed reaction
F
Patch testing:
F
Intradermal testing with delayed readout:
E
Drugs to be used in patch testing are mixed into petrolatum or 0.9 percent saline, applied to a small area of
skin under occlusion for 48 hours, and then removed.
F
The site is examined 48 to 96 hours after placement.
F
This type of testing should only be performed if a commercially available injectable form of the drug is
available.
F
The concentration used should be known to be non-irritating, and a prick test should be performed initially
to assure there is no immediate response
F
A positive result consists of erythema and induration at the site, and the site is examined at 24 to 48 hours
after placement
D
Test Dosing (Or Graded Challenge)
Indications
Contraindications
D
Indicated to exclude immediate allergic reactions.
K
The purpose of a test dose is to expose the patient to a small amount of drug, followed by a period of
close observation, in case there is a reaction.
I
used to exclude allergy to the medication in question, and is most appropriate for
a patient who is unlikely to be allergic to that drug.
F
should not be performed in a patient with a positive response in a prior drug
allergy test (skin or in vitro).
J
only when immediate allergy to the tested antibiotic is judged to be
unlikely after careful consideration of the details of the past reaction.
F
Patients with mild past reaction to penicillin that lacked features of an IgE-mediated allergy.
F
Patients with mild past reaction to penicillin that occurred more than 10 years ago, even if it
involved hives or angioedema,
F
In contrast, if a patient’s history is vague but some element of it suggests a serious IgE-mediated
reaction (eg, “My mother said that I could not breathe”), then the more cautious approach of
performing a
D
does not modify the allergic response to the drug or prevent recurrent
reactions. Therefore:
F
Graded challenge to the suspect drug is contraindicated in patients
with the following types of reactions:
V
Blistering dermatitis (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis)
F
Sloughing of the skin
C
Severe generalized hypersensitivity reactions involving internal organs (drug-induced
hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms)
F
Milder dermatoses with mucous membrane lesions (eg, erythema multiforme)
F
The starting dose is usually 1/10th of the full dose, but could be higher or lower,
depending on the route of administration, clinical stability of the patient, and level of
certainty that the patient is not allergic to the drug.
D
usually 1/4th or 1/10th of
the full dose
V
Low risk history:
F
Moderate risk history
F
High-risk history
F
Isolated nonallergic symptoms (eg, gastrointestinal symptoms) or
F
Patients solely with a family history of a penicillin allergy,
F
pruritus without rash,
U
remote (>10
years) unknown reactions without features suggestive of an IgE- mediated reaction
Y
Low risk history:
Action :
For patients with nonallergic symptoms or a family history:
For patients with other low-risk histories, such as pruritus without rash or remote (>10 years)
unknown reactions without features suggestive of an IgE-mediated reaction:
I
Amoxicillin can be prescribed,
V
However, patient preference may dictate whether a direct oral amoxicillin challenge is performed under medical
observation first.
O
direct oral amoxicillin challenge under medical observation should be performed
U
urticaria or other pruritic
rashes or reactions with features of IgE-mediated reactions (eg, swelling), but not
anaphylactic reactions
I
patients receiving supplemental oxygen
F
compromised cardiac function,
9
pregnant patients
I
Moderate risk history
Actions
F
Skin test and amoxicillin challenge
F
Patients with positive skin test are allergic to penicillin and should not be challenges.
F
Negative skin test can be followed by oral amoxicillin challenge
I
High-risk history
Action
K
Patients with a history of high-risk reactions, including anaphylaxi
D
positive
penicillin skin testing results
U
recurrent penicillin reactions,
F
hypersensitivities to multiple β-lactam
antibiotics, should be evaluated by specialists.
U
If penicillin is required immediately for optimal patient care, a …. procedure may be pursued.
L
is reserved for scenarios in which penicillin or a penicillin-related drug is superior to
alternative antibiotics.
I
induction of tolerance procedure, is used in the context of a history of an IgE- mediated
hypersensitivity reaction (HSR) or a positive skin test.
Y
procedure uses gradual steps (often 12-step protocols) to build temporary tolerance to a drug by rendering
effector cells (e.g., mast cells, basophils) less reactive in a controlled setting that does not cause overt
anaphylaxis.
8
Desensitization
Indication
O
had elevated tryptase during the initial reaction (indicating mast cell activation),
I
strongly suspected to have an immediate-type drug allergy based on clinical history
D
whom there are no acceptable alternate drugs.
F
Desensitization
Contraindication
Safety
S
never attempted in patients with histories of reactions involving
significant skin desquamation, such as Stevens-Johnson
syndrome or toxic epidermal necrolysis
Y
Erythema multiforme and diffuse erythroderma with desquamation
U
drug reaction with eosinophilia and
systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DiHS),
I
acute generalized exanthematous pustulosis (AGEP), serum sickness
reactions, nephritis, hepatitis,
G
Cross reactivity between B lactam antibiotics
U
Amoxicillin has side chain that are identical to
K
Ampicllin has side chain that are identical to
S
Cefadroxil
D
Cefprozil
S
Cefatrizine
D
Cefaclor
S
Cephalexin
S
Cephradine
D
Cephaloglycin
D
Loracarbef
S
Management of Drug Challenge Reactions
O
Not tolerance
D
Serious type of delayed
D
Past reaction was mild without feature of IgE
D
Past reaction did have feature of IgE
S
Treatment
Immediate
Delayed
Not allergic
D
Drugs for anaphylaxis reaction
V
Emergency management of anaphylactic reaction in adults
F
I’m epinephrine
D
Oxygen
D
Normal saline rapid bolus
D
Albuterol ( salbutamol )
D
H1 antihistamine
D
H2 antihistamine
L
Diphenhydramine
D
Famotidine
P
Methylprednisolne
D
Glucagon
D
Sulfonamide
Reaction
Treatment
D
O
Medications in the nonantimicrobial group do not contain … groups and are associated only rarely with
hypersensitivity reactions.
.
not a sulfonamide but can cause hypersensitivity reactions similar to those caused by sulfonamides
V
Dapsone
S
fever and morbilliform rash, sometimes accompanied by organ involvement, beginning one to two weeks after the start of therapy.
9
serum sickness-like reactions and immunoglobulin (Ig)E-mediated allergic reactions.
O
Highly associated with the rare blistering reactions Stevens-Johnson Syndrome (SJS) and toxic epidermal
necrolysis (TEN).
I
There is minimal evidence of cross-reactivity between the antimicrobial sulfonamides and the nonantimicrobial
sulfonamides.
P
the only safe approach if a patient describes symptoms consistent with any type of blistering dermatitis or diffuse erythroderma
I
Flouroquinolone
L
The two most common types of hypersensitivity reactions to fluoroquinolones
O
Cross-reactivity among the fluoroquinolones for this type of reaction appears to be low
V
suggest identifying a safe alternative using a graded challenge with a fluoroquinolone, other than the one that caused the reaction
D
Patch testing is not useful
G
There is evidence of cross-reactivity
D
Vancomycin
C
Vancomycin infusion reaction VIR:
P
Flusing, erythema, pruritus for the upper body usually
P
Prevented by administering the drug at rates ≤10 mg/minute (or 1 gram over
more than 100 minutes).
P
patients who require higher infusion rate (above 10 mg/minutes or 1 g over
hour): antihistamine premid (can combine anti H1 + H2)
P
Vancomycin
Mild
Moderate
Sever
F
Macrolide
D
Aminoglycoside
S
Tetracycline
D
Clindamycin
S
Metronidazole
D
