INF1 - A. ALLERGY, INTOLERANCE AND ADR'S-COVERED

Question 1

what is an allergy

Answer 1

chronic condition involving an abnormal reaction to an allergen (ordinarily harmless substance)

Question 2

what could be listen as an allergy but isn’t

Answer 2

drug MOA
error
coincidence
symptoms
side effects
intolerance

Question 3

who is in the exclusion criteria for penicillin allergy challenge

Answer 3

medically unstable (NEWS ≥2)
pregnant
uncontrolled asthma
unstable coronary artery disease
on an ACE inhibitor or beta blocker unless can be withheld 24 hours before

Question 4

what is preparation for penicillin allergy challenge

Answer 4

• oral antihistamines should be stopped 72 hours prior to challenge (may mask true allergy)
• select the antibiotic to which the patient had the reaction (if don’t know, amoxicillin)
• discuss plan, give patient info sheet
• record in case notes that consent has been obtained

Question 5

what is step 1

Answer 5

history suggestive of type 4 hypersensitivity reaction?
- rash with blistering
- oral or genital ulceration or blistering
- rash associated by a severe systemic illness requiring admission to hospital

Question 6

what is step 2

Answer 6

assess the history of the penicillin allergy to determine risk of type 1 hypersensitivity
- collapse
- facial/throat swelling
- breathing difficulties
- itchy rash

Question 7

what is the procedure for the allergy challenge

Answer 7

• measure patient’s observations
• medical staff prescribe and administer antibiotic, remain in clinical area for first 20 minutes
• single oral dose amoxicillin 500mg/ flucloxacillin 500mg
• inform patient to notify immediately if they experience any adverse symptoms
• measure patient’s observations if they experience any symptoms and at regular intervals
• record any symptoms the patient experiences
• symptoms of a positive test or a rising NEWS2 score, review immediately by senior staff

Question 8

what is the post-procedure care for the allergy challenge

Answer 8

• interpret the oral challenge
• if negative, give patient PIL, record in discharge letter, ask patients GP to amend their allergy status on practice records
• if challenge outcome is positive, written and electronic record must state this, give patient PIL and inform GP

Question 9

what is a positive test for penicillin allergy

Answer 9

itchy rash
breathing difficulties
facial swelling
hypotension