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A patient Case (admission : 2017. April 15)

A patient Case (admission : 2017. April 15)

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• The antibiotics most likely to cause an allergic reaction are penicillins and

cephalosporins.

• Mild symptoms include red, itchy, flaky, or swollen skin.

• Severe symptoms include skin that blisters or peels, vision problems, and

severe swelling or itching. Severe reactions include conditions such as toxic

epidermal necrolysis (TEN).

• Anaphylaxis symptoms include throat tightness, trouble breathing, tingling,

dizziness, and wheezing.

• Anaphylaxis is a sudden, life-threatening reaction

** Anaphylaxis may occur if you exercise after exposure to a trigger,

such as after taking an antibiotic



• Other allergies, such as to cats

• A family history of antibiotic allergies

• Frequent use of antibiotics

• A long-term illness that makes your immune

system more sensitive



• Specific

• Sensitive

• Simple to perform

• Rapid (result in 15-20 min)

• Educational for patient



• More sensitive than SPT

• May Induce false positive reactions

• May induce systemic reactions

• Sould be done only if skin prick test is

negative and allergen is highly suspect



• Penicilline is only drug with well-validated outcomes

• There are no validated diagnostic tests for evaluation of IgEmediated allergy to non-penicillin antibiotics

• A negative skin test results does not rule out the possibility

of an immediate type allergy



Empedrad R et al. J Allergy Clin Immunology 2003



Commercially available

Phadia CAPđ/ImmunoCAP(fluorescent enzyme immunoassay, FEIA)



• Less sensitivity and more expensive compared to skin testing

– Sensitivity for penicillins/amoxicillin from 38-54%

– Specificity for penicillins/amoxicillin from 87-100%



• Results

– Positive ≥ 0.7 kU/L (Class 2)



Nasr et al., J Med Microb Diagn 2016



• Antihistamines: decrease mild symptoms such as itching or a rash

• Epinephrine : to treat severe allergic reactions such as anaphylaxis

• Steroids: reduce inflammation

• Desensitization : gradually exposed to small doses

( if you need to be treated with the antibiotic again)

** Most patients lose their penicillin allergy over time, even patients with a

history of severe reaction such as anaphylaxis



Antipyretics and Drug Allergy



Kim CK et al. Pediatr Int. 2013



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A patient Case (admission : 2017. April 15)

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