History Of Antibiotic Allergy Research Articles

The Role of Medical History and Allergic Tests in the Analysis of Antibiotic Allergy in the Pediatric Population

The Role of Medical History and Allergic Tests in the Analysis of Antibiotic Allergy in the Pediatric Population

History-based preoperative evaluation of antibiotic-related allergies and design of an easy to use questionnaire.

An unconfirmed history of antibiotic allergies may negatively influence prescribing patterns for preoperative antibiotic prophylaxis and increase rates of postoperative wound infections through unnecessary use of alternative antibiotics. After a literature search, we developed aquestionnaire for the structured collection of antibiotic allergy history in the anesthesia consultation center and tested it over 2 years at atertiary care hospital under everyday conditions as part of aquality assurance project. All data were evaluated completely anonymously in the context of standard care. After refining the questionnaire, we analyzed 4866 recorded optimized questionnaires, of which51 were incomplete. An antibiotic allergy was denied 4312times and affirmed 503times, which corresponds to 10% in our sample. The most frequent single substances or groups in the 503 respondents with apositive history of antibiotic allergy were penicillin in 271 (54%), amoxicillin in65 (13%), an unknown single agent in50 (10%) and multiple substances in25 (5%). The reported event occurred more than 10years ago in 192 (38%) of the respondents, less than 10years ago in 116 (23%), and 195 (39%) could not provide information. The time from exposure to symptom onset was less than 1h in96 (19%), between 1 and 24 h in75 (15%), more than 24 h in 106 (21%), and the remainder could not provide information. Allergy-specific treatment was recalled by75 (15%) respondents, 287 (57%) reported not having received specific treatment, and the remainder could not recall. Aspecific allergy test was reported by55 (11%) respondents, 337 (67%) said no allergy test had been made, and the rest could not recall. Asubstance-specific allergy passport was issued in80 (16%) respondents. According to expert assessment, symptoms compatible with an IgE-mediated reaction were present in96 (19%) of the respondents. An IgE-mediated reaction was considered possible in70 (14%) and could be excluded by history in 337 (67%) of respondents. Out of 503 respondents with apositive history 51(10%) could not remember the allergic substance but7 (14%) of the 51reported symptoms compatible with severe anaphylaxis or anaphylactic shock and6 of the51(12%) reported symptoms possibly related to an IgE-mediated reaction. Our survey revealed approximately 10% of respondents reporting an antibiotic allergy, which is in the upper range of data published in international literature and corresponds most closely to American data. Thus, the topic is also relevant to German anesthesia consultation centers, given the high rate of respondents who could have been "delabeled" based on the comprehensive assessment of their history. More expert allergy testing is needed in patients who report symptoms related or probably related to an IgE-mediated reaction. In our opinion, aspecial issue exists in those patients who did not remember the exact antibiotic but reported symptoms compatible with severe anaphylaxis putting them at high risk of unintended re-exposure.

Use of clindamycin as an alternative antibiotic prophylaxis

BackgroundClindamycin serves as an alternative surgical prophylactic antibiotic in patients with penicillin (PCN) or cephalosporin allergy labels. In the previous reports, the use of clindamycin was associated with higher incidences of surgical site infections (SSIs). We aimed to determine the characteristics of PCN or cephalosporin allergic reactions to stratify patient's risk and indicate subsequent management; leading to de-labeling of PCN or cephalosporin allergy. MethodsWe conducted a prospective cohort study of patients receiving clindamycin as surgical antibiotic prophylaxis from September 2021 to March 2022. Data were collected from electronic medical records; included demographic data, antibiotic allergy labels, allergic reaction, and allergy testing. ResultsClindamycin was administered in 445 patients who underwent 451 operations. Among these patients, 53.0% (n = 236) were female with a median age of 15 years (range; 0.5–57.0 years). PCN and cephalosporin allergies were labelled in 83.8% (n = 373) and 25.6% (n = 114) patients, respectively; 11.4% (n = 51) of patients were allergic to both classes of the antibiotics. There were 191 (51.2%) and 73 (64.0%) possible hypersensitivity reactions (HSRs) in PCN and cephalosporin groups, respectively. The most common reactions were rash (PCN: n = 99, 26.5%; cephalosporin: n = 35, 30.7%), and hives (PCN: n = 71, 19.0%; cephalosporin: n = 24, 21.1%). Severe reactions included angioedema (PCN: n = 7, 1.9%; cephalosporin: n = 5, 4.4%), anaphylaxis (PCN: n = 8, 2.1%; cephalosporin: n = 7, 6.1%), bronchospasm (cephalosporin: n = 1, 0.9%), airway involvement (PCN: n = 1, 0.3%; cephalosporin: n = 1, 0.9%), serum sickness (PCN: n = 1, 0.3%), blisters (PCN: n = 1, 0.3%), and drug reaction with eosinophilia and systemic symptoms (DRESS) (PCN: n = 1, 0.3%). Low-risk history of allergy included gastrointestinal side effects (PCN: n = 9, 2.4%; cephalosporin: n = 3, 2.7%), positive family history (PCN: n = 7, 1.9%; cephalosporin: n = 1, 0.9%), and remote history of allergy (PCN: n = 2, 0.5%). There were 201 (53.9%) and 53 (46.5%) unknown reactions in PCN and cephalosporin groups, respectively. In the overall cohort, 3 patients (0.7%) were skin tested for drug allergy (PCN: n = 2, 0.5%; cephalosporin: n = 2, 1.8%). ConclusionClindamycin was largely administered in patients with non-severe HSRs, low-risk history or unknown reactions to PCN or cephalosporin, whom cefazolin could have been administered safely. Obtaining a detailed history of antibiotic allergy, allergy testing and/or direct oral challenge can de-label unsubstantiated PCN or cephalosporin allergy and ultimately reduce the incidence of SSIs by optimizing the rate of more effective antibiotic administration.

The Effect of Beta-lactam Allergy Status on the Rate of Surgical Site Infections: A Retrospective Cohort Study.

To determine if patients with reported BL allergies have increased odds of developing SSI compared to reported NBL allergic patients. SSI represent a significant risk of morbidity and mortality for patients. Cefazolin-based perioperative antibiotic prophylaxis is the guideline-recommended drug-of-choice for most procedures. Due to over-reporting of BL allergies, many patients may not receive guideline-directed cephalosporin-based prophylaxis, which may result in an increased SSI rate. A single-center retrospective cohort design study was performed. Data was collected on all targeted surgical procedures: cesarean section, vaginal, and abdominal hysterectomy, colon, laminectomy, and spinal fusion surgeries. During the study period, 2676 procedures were analyzed with 454 (17%) and 2222 (83%) in reported BL and NBL allergic cohorts, respectively. Significantly more SSI developed in the BL cohort versus NBL cohort (3.1% vs 1.5%, odds ratio 2.015; 95% confidence interval, 1.090-3.724; P = 0.023). Through a multivariate logistic regression, receipt of a NBL antibiotic regimen was the only variable to have a significant effect on SSI rate (adjusted odds ratio, 3.815; 95% confidence interval, 1.142-12.749; P = 0.030). Reported BL allergic patients have an increased odds of developing SSI in comparison to NBL allergic patients. The increased risk is likely related to administration of NBL antibiotic regimens in comparison to BL-based regimens. Thorough antibiotic allergy history collection can be a valuable SSI prevention tool to safely increase the proportion of patients receiving BL regimen.

Penicillin-Allergie – tödliche „Fake News“ in der Krankenakte?

The note "penicillin allergy" in the medical record is given in the literature with a prevalence of 8 - 12% and represents the most frequently reported "allergy". However, there are a number of hypersensitivity reactions of which true anaphylaxis is only a small part. Therefore, a specific allergy history should be included in the file for patients with suspected penicillin allergy. Even a simple survey can identify those patients who can easily obtain cephalosporin, especially cefazolin. Any unclear history of antibiotic allergy should be followed by a stepwise allergological diagnosis. This is because suspected allergies are associated with an increased rate of postoperative wound infections when alternatives to preoperative prophylaxis are used and a general increase in mortality, presumably due to poorly effective therapies and increased side effects. The article explains the risk stratification for the evaluation of a penicillin allergy, shows reasons for insufficient clarification and incorrect documentation of allergy anamnesis and describes diagnosis and therapy of true anaphylaxis.

Лечение острого неосложненного цистита у женщин с аллергией или непереносимостью антибиотиков

A comparative evaluation of the efficacy and safety of Canephron N and Cystone as monotherapy in women with acute uncomplicated cystitis and antibiotic allergy or intolerance was performed. A prospective, randomized, controlled study of drug Canephron N as monotherapy for acute uncomplicated cystitis in 51 women with a history of antibiotic allergy or intolerance was carried out in 3 urological centers in Perm from 2016 to 2019. In the main group, patients received Canephron N for 30 days, while in comparison group, Cystone was prescribed. The Acute Cystitis Symptom Score (ACSS), microscopic study of urine sediment, urine culture and other methods were used. Results were evaluated 3, 6, 30 days and 1 year after the start of treatment. In the main group, monotherapy with Canephron N for 30 days resulted in a decrease in the total ACSS score from the baseline 12.9 to 0.3 points, while in Cyston group, changes of ACSS score were less pronounced, from baseline 12.8 to 1.4 points (p<0.01). Clinical cure rate in the main and comparison group was 88.5% and 68%, respectively. In another 3.8% and 1% of patients in the main and comparison group, an improvement was seen. The number of patients with leukocyturia in the Canephron N group decreased to 11.5% compared to 28% in Cyston group (p>0.05). Bacteriuria rate in the main group was 7.7%, which was less than in the comparison group (20%, p>0.05). Number of sick days in the main group was 4.9+/-0.4, compared to 7.4+/-0.6 days in Cyston group. In the Canephron N group, 1-year recurrence rate was only 7.7%, while in the Cyston group the recurrence was seen in 16% of patients. According to the results, Canephron N is an effective and safe drug as monotherapy for acute uncomplicated cystitis, and can be considered as drug of choice for the treatment of women with antibiotic allergy or intolerance.

1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing

BackgroundWhen considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care.MethodsUsing local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms.ResultsThe smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials.ConclusionScript for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis. Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed. Disclosures All authors: No reported disclosures.

ANTIBIOTIC ALLERGIES IN PATIENTS WITH AND HIGH RISK FOR NEUTROPENIA: A QUALITY IMPROVEMENT OPPORTUNITY

Introduction Standard therapy for patients with neutropenic fever is treatment with an antipseudomonal antibiotic. Patients with a history of self-reported penicillin allergy are often given alternative antibiotic regimens; however, up to 90% of these patients do not have IgE-mediated hypersensitivity and thus are inappropriately labeled as allergic. The effects of documented penicillin allergy on outcomes have been recognized: higher hospital charges, increased risk for surgical complications, and recently, increased rates of clostridium difficile infection and mortality in patients with hematologic malignancies. Methods A retrospective chart review was performed on patients admitted with ICD-9/10 diagnoses that identified them as having neutropenic fever/sepsis or acute leukemia. 1400 patients were identified and separated into two cohorts based on the presence of an antibiotic allergy. The outcomes investigated included AKI, clostridium difficile infection, mortality, MRSA and VRE colonizations. Results The absolute rates of AKI, clostridium difficile infection, mortality, MRSA and VRE colonizations were higher in the antibiotic allergy group compared to the non-allergy group: 6.8% difference in AKI, 1.9% in clostridium difficile infection, 7.6% in mortality, 0.2% in MRSA colonization, and 3.6% in VRE colonization. Conclusions We found higher rates of adverse events in patients at high risk of antibiotic use with documented antibiotic allergies. These findings confirm previously published work and extends the adverse outcomes of AKI, MRSA and VRE colonizations, further demonstrating that antibiotic allergy history is not benign. Thus, quality improvement opportunities exist to appropriately identify or disprove antibiotic allergies in patients who are at high risk for antibiotic use.

Antibiotic prophylaxis in cesarean section and other surgical procedures: a Korean national assessment system

Prophylactic antibiotic management is a major issue in surgical patients, as the postoperative risk of infection is very high, especially in vulnerable populations. Westen et al. reported that a single dose of prophylactic ampicillin and metronidazole is as effective as a multiple-day regimen of these antibiotics, which would allow a significant dose reduction while decreasing healthcare costs 1. Between 2005 and 2006, the Korean Ministry of Health and Welfare began assessment of antibiotic prescriptions for surgical patients. In 2007 it extended the assessment program to include antibiotic prophylaxis in patients undergoing hysterectomy and cesarean section 2. Since then, prophylactic antibiotic monitoring has been extended annually and now includes gastric, heart, knee, thyroid, and breast operations, as well as neurosurgery, and more. As of 2014, 15 types of surgery were covered by the assessment program 2. Among the 12 parameters evaluated in the program are prophylactic antibiotics administration one hour before the first indication, dose of antibiotics, rates of aminoglycoside administration, rates of third-generation cephalosporin administration, rates of co-administered prophylactic antibiotics, antibiotic prescription rates at discharge, total average number of days of prophylactic antibiotic administration, and history of antibiotic allergy 2. The exclusion criteria are based on clinical symptoms and diagnosis. Thus, patients with three days of high fever postoperatively, infection, transfusion of >4 units of blood within 24 h postoperatively, drainage of an abscess at the surgical site, pneumonia, sepsis, and/or disruption of the surgical wound or other evidence of serious infection are excluded from the assessment. Based on the results, hospitals are ranked in five levels, which are reported annually on the website of the Korean Ministry of Health and Welfare and in Korean newspapers. Korea has a national insurance system that contributes to the cost of surgical procedures. In 2014, the government started a hospital incentive system based on the above-mentioned rankings. Thus, the government pays more to high-ranking and less to low-ranking hospitals. In 2014, 11 hospitals qualified for the incentive program 2. In view of the legal problems that confront surgeons whose patients experience postoperative infectious complications, a surgeon cannot initiate a reduction in prophylactic antibiotics. The primary goal of the assessment is to reduce antibiotic abuse and medical costs while improving the quality of surgical care. According to a health insurance review, in 2009, total antibiotics use per operation had decreased by 36.4% compared with 2006 2. The program to reduce prophylactic antibiotic use in surgical patients was initiated by the government health system, not by surgeons. However, the Korean data have made an important contribution to surgical practice and to the development of government health insurance policies.

Diffuse Desquamating Rash Following Exposure to Vancomycin-Impregnated Bone Cement.

To describe a case of systemic desquamating dermatitis following implantation of vancomycin antibiotic-laden cement (ABLC) in a patient with prior history of Stevens-Johnson (SJS) reaction to vancomycin. A 59-year-old man with a history of SJS reaction to systemic vancomycin and recurrent methicillin-susceptible Staphylococcus aureus prosthetic knee infection developed a painful, blistering rash after implantation of bone cement that had been mixed with 2 g of vancomycin. He was started empirically on steroids by his primary care provider and had desquamation about 1 week later. Systemic absorption of antibiotics from ABLC has been well documented in the literature. Reports of systemic toxicity are rare, and none have described systemic allergic reactions to vancomycin. This patient's prior episode of SJS was diagnosed at another academic medical center 6 years ago, and records are unavailable. Following low-level reexposure to vancomycin, he developed a diffuse painful desquamating rash. Application of the Naranjo nomogram yielded a score of 8 (probable adverse reaction). Although he did not experience fever, sore throat, or mucous membrane involvement to fulfill classic features of SJS, we believe that his severe rash represented a less-severe form of a systemic hypersensitivity reaction to vancomycin. Antibiotics contained in ABLC are systemically absorbed, though at low levels, and have been associated with systemic toxicities. Antibiotics to which a patient has had a potentially life-threatening reaction should not be used in ABLC. Particular attention should be paid to an individual's antibiotic allergy history prior to implantation of any ABLC.

Reported Antibiotic Allergy History and Outcomes in Patients Hospitalized with Community-Acquired Pneumonia

Reported Antibiotic Allergy History and Outcomes in Patients Hospitalized with Community-Acquired Pneumonia

Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: a cross sectional study.

BackgroundAntibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios.MethodsA cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women).ResultsA total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases.ConclusionsWe observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.

Antibiotic allergy: outcome of oral challenge

<h3>Introduction</h3> Many children who are thought to have antibiotic allergy may in fact not be so. Children who have this unnecessary label of drug allergy are subjected to lifelong avoidance and possibly being prescribed less effective and more costly treatment. Investigations in these children are challenging and may include skin prick tests, drug radioallergosorbent test (RAST) level and oral challenge. <h3>Aim</h3> The authors want to look at the outcome of our oral antibiotic challenge, the adverse effect and how it relates to clinical history, skin prick test and RAST levels. <h3>Methods</h3> The authors retrospectively collected data of children (0–16 years old) who underwent drug challenges in our day care unit and for the subsequent 5 days at home with instructions to inform the team with any symptoms suggestive of allergy. The data are from January 2007 to July 2009. Data were collected from review of case notes and were systematically analysed. <h3>Results</h3> The authors had 71 cases over that time period. Most of them have been referred by the general practitioner (39, 55%). Seven cases (9.8%) did not have any previous positive history of antibiotic allergy but were referred due to concerns over strong family history. The most common antibiotic being challenged is amoxicillin followed by penicillin. All cases had either or both skin prick test or RAST level being negative except for one case where none of these tests were done but the antibiotic challenge was successful. The authors had only one (1.4%) failed oral antibiotic challenge. This child had a negative skin prick test and RAST level. It was manifested as a mild rash on legs after 2.5 ml of antibiotics in day care unit. The child was given antihistamine and symptoms resolved. This child has not had any positive reactions in the past but was tested due to strong family history of antibiotic allergy. <h3>Conclusion</h3> Over the 2 ½ years, the authors had only one failed oral antibiotic challenge (1.4%), which re-iterates the fact that true antibiotic allergy is not common. From our data, this shows that a positive clinical history correlates poorly to true antibiotic allergy.

A new basophil activation test using CD63 and CCR3 in allergy to antibiotics

Flow cytometric basophil activation tests (BAT) have been developed as cellular tests for in vitro diagnosis of IgE-mediated reactions. Different markers and techniques have been used after stimulation with various allergens. It was the aim of the present study to compare an established BAT (Flow-CAST) with a newly developed basophil activation protocol using CD63 and CCR3 (Flow2 CAST) in patients with type-I allergy to antibiotics. Twenty-four patients with a history of type-I allergy to antibiotics were examined. A careful allergy history was taken, and skin tests and determination of specific IgE antibodies were performed. Two different BAT using CD63 expression but different protocols were carried out after stimulation with different concentrations of antibiotics. Fifteen healthy subjects without a history of antibiotic allergy were studied as controls. The Flow2 CAST showed a higher sensitivity than the Flow-CAST (55% vs. 53%) with regard to patients' history. Specificity was 80% both for the Flow2 CAST and for the Flow-CAST with regard to controls with negative history and negative RAST. These results show the value of two different BAT as cellular tests in the in vitro diagnosis of patients with antibiotic allergy with equal specificity and a slightly higher sensitivity for the Flow2 CAST.

Severe anaphylactic reaction after intracameral antibiotic administration during cataract surgery

We read with interest the case report by Villada et al.1 commenting on the overall safety of routine cataract surgery using topical anesthesia after a single case observation of severe anaphylactic reaction triggered by an intracameral antibiotic. However, we do not concur with their argument. First, the eye is an immune-privileged organ, mostly evidenced in the anterior chamber.2 The anaphylactic reaction observed in this patient must have been the result of presentation of the culprit antibiotic molecules to the antigen-presenting cells within the bloodstream, triggering immunoglobulin E–mediated type-I hypersensitivity.3 Conceptually speaking, intracameral antibiotic administration in a patient with a history of antibiotic allergy is highly akin to the direct intravenous route of administration in terms of bioavailability, particularly in the face of a disrupted blood–aqueous barrier during phacoemulsification. Occurrence of anaphylactic reaction in this circumstance is not as unexpected as that supposed by the authors. The idiosyncrasy of intraocular delivery of immunogen has nothing to do with most of the standard steps of topical anesthesia cataract surgery. Second, nowadays, topical anesthesia cataract surgery is largely practiced without the addition of an intracameral antibiotic.3 Even in cases with intracameral antibiotic injection, Ragusa et al.4 have indicated, using a retrospective review of 2206 participants, that the risk for systemic anaphylaxis is as low as 0.06%. Understanding the standard art of practice in topical anesthesia cataract surgery, the pharmacokinetics of intracameral antibiotics, and the risk for systemic anaphylaxis may make the authors' generalization dubious.

Reduction of Vancomycin Use in Orthopedic Patients With a History of Antibiotic Allergy

To reduce prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery by using a targeted allergy consultation and penicillin allergy skin testing. The participants in this practice improvement study were patients with a history of penicillin or cephalosporin allergy who were scheduled for elective orthopedic surgery and referred by orthopedic surgeons for allergy consultation and penicillin allergy skin testing between September 22, 1998, and April 15, 1999. The primary outcome measure was the percentage of participants who received prophylactic cefazolin during the study period compared with historical controls. Of the 60 study patients, 59 received a penicillin allergy skin test, 58 underwent orthopedic surgery, and 55 received antibiotic prophylaxis. Fifty-five patients had a history of allergy to penicillin, a cephalosporin, or both, and 5 had a history of nonspecific antibiotic allergy. Of the 59 patients, 55 (93%) had negative penicillin allergy skin test results. Fifty-four (90%) of the 60 patients were given clearance by the allergist to receive cefazolin. Of the 55 study patients who received antibiotic prophylaxis, 6 (11%) received vancomycin compared with 38 (30%) of 127 historical controls (P < or = .05). None of the study patients had an immediate reaction to cefazolin or to vancomycin. Prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery can be reduced by a targeted allergy consultation and penicillin allergy skin testing.

999 Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy

999 Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy

Evidence for familial aggregation of immunologic drug reactions

Immunologic drug reactions (IDRs) are an important cause of morbidity and mortality.1,2 There is some evidence that IDRs aggregate in families. One study of the children of parents who are allergic to an antibiotic by history found a 15-fold relative risk for histories of reactions to antibiotics in these children relative to controls without a positive family history of antibiotic allergy.3 Drug-induced immune nephropathy in patients with rheumatoid arthritis treated with gold or penicillamine has been associated with the HLA-DR3 phenotype.