Journal
CURRENT OPINION IN PEDIATRICS
Volume 34, Issue 6, Pages 609-615Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MOP.0000000000001171
Keywords
anaphylaxis; drug allergy; oral challenge; pediatric
Categories
Funding
- AAAAI Foundation Faculty Development Award
- National Institutes of Health [R01HG010863, R01AI152183, U01AI154659, R13AR078623, UAI109565]
- National Health and Medical Research Council of Australia
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The purpose of this review is to identify recent advances in our understanding and management of immunoglobulin E (IgE)-mediated antibiotic allergy.
Purpose of review The purpose of this review is to identify recent advances in our understanding and management of immunoglobulin E (IgE)-mediated antibiotic allergy. Recent findings Antibiotics remain a leading cause of fatal anaphylaxis reported to the FDA. However, recent advances have defined the features of adult and pediatric patients without true IgE-mediated allergy or any mechanism of anaphylaxis when tested. This has created opportunities to use direct challenges to disprove these allergies at the point-of-care and improves antibiotic stewardship. Additional advances have highlighted cross-reactive structural considerations within classes of drugs, in particular the R1 side-chain of cephalosporins, that appear to drive true immune-mediated cross-reactivity. Further advances in risk-based approaches to skin testing, phenotyping, and re-exposure challenges are needed to standardize antibiotic allergy evaluation. Recent advances in defining true IgE-mediated drug allergy have helped to identify patients unlikely to be skin-test positive. In turn, this has identified patients who can skip skin testing and proceed to direct ingestion challenge using history risk-based approaches. The ability to identify the small number of patients with true IgE-mediated allergy and study their natural history over time, as well as the vast majority without true allergy will facilitate important and novel mechanistic discoveries.
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