Management of B-lactam allergy + stewardship Flashcards
Can patients out grow an IgE allergy? How long does it take?
Yes
50% can tolerate it after 5 years
80% after 10 years
What are harms of false penicillin allergy labels?
Patients are given 2nd-line drugs for illness
- more side effects
- higher cost
- increased risk of treatment failure
Explain beta-lactam cross reactivity with Type II reactions
Drug-specific
- can try a different beta-lactam
Explain beta-lactam cross reactivity with Type III and type IV-2 reactions
Avoid ALL beta lactams
Explain beta-lactam cross reactivity with mild Type IV reactions
Does not require ANY avoidance of beta-lactams
- could use the same drug, or switch to another b-lactam
Explain beta-lactam cross reactivity with Type I IgE reactions to penicillin
- Avoid all penicillins
- switch to a different side chain of cephalosporin (B-lactam) or carbapenems (if serious)
Explain beta-lactam cross reactivity with Type I IgE reactions to cephalosporins
- use cephalosporin or penicillins with a DIFFERENT side chain
What therapy do you use if they have onset of 72 hours+ with type II, Type III, Type IV-2 reaction to penicillin? What symptoms
Symptoms:
- SJS
- Toxic epidermal necrolysis (TEN)
- immune hepatitis
- DRESS
- Serum sickness
- hemolytic anemia
- intersistial nephritis
Therapy
- AVOID ALL B-LACTAMS
What therapy do you use if they have onset of 72 hours+ with delayed reaction to penicillin? What symptoms/type?
Symtpoms: (type IV-mild reaction)
- non-pruritic rash
- maculopapular rash
Therapy:
- use different beta-lactam (side chains don’t matter)
What therapy do you use if they have intolerance to penicillin? What symptoms/type?
Symptoms:
- Diarrhea
- N/V
- Headache
- candidiasis (vaginal thrush)
Therapy
- OKAY to use b-lactam therapy
What therapy do you use if they have onset within 72 hours reaction to penicillin? What symptoms/type?
Symptoms: Type 1 IgE mediated
- anaphylaxis
- hypotension
- bronchochonstriction
- allergic rhinitis
- stridor
- angioedema
- uticaria
Therapy:
- refer to allergist
- avoid all penicillins & b-lactams with the SAME side chain
- USE cephalosporins with DIFFERENT side chains
What can increase the risk for hypersensitivity (3)
cancer, HIV, immunocompromised
Describe which type is each symptom
Fever
Wheezing, shortness of breath, swelling, low BP
Maculopapular rash
Urticaria
Skin sloughing
Lesions in lip/mouth
Fever
- type 2,3, 4-serious
Wheezing, shortness of breath, swelling, low BP
- IgE Mediated type 1
Maculopapular rash
- Type 4-mild
Urticaria
- IgE Type 1
- Type 2- vasculitis (rare)
Skin sloughing
- Type 4-serious
Lesions in lip/mouth
- Type 4-serious
What information can you get when you ask how long ago did the reaction ocur?
Could they have outgrown it? IF IgE ONLY
50% can tolerate it after 5 years
80% after 10 years
When to refer?
Any patient who is receiving 2nd line treatment (cephalosporin) due to possible IMMEDIATE reaction (type 4 serious)
