Clindamycin desensitization in an AIDS patient

Marcos, Carmen; Sopeña, Bridget C.; Luna, Izaildo Tavares; González, Rosendo Bugarín; Fuente, J. De La; Martínez-Vázquez, C.

doi:10.1097/00002030-199510000-00017

Cited by 27 publications

(13 citation statements)

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“…Desensitization for type I hypersensitivity reactions in penicillin‐allergic patients was first developed more than 50 years ago (88). Other empiric protocols were developed to treat hypersensitivity reactions to essential drugs that could not be substituted, such as antibiotics (89–102), allopurinol (103), aspirin (104) and clopidogrel (105), insulin (106), chemotherapy agents (107, 108), and biologics (109, 110). Secondary prevention relies mainly on identification of allergic patients, avoidance of the culprit drug and drugs that cross‐react and use of a Medic‐Alert bracelet (8).…”

Section: Management Of Anaphylaxismentioning

confidence: 99%

Anaphylaxis: past, present and future

Ben‐Shoshan

Clarke

2010

Allergy

157

140

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To cite this article: Ben‐Shoshan M, Clarke AE. Anaphylaxis: past, present and future. Allergy 2011; 66: 1–14. Abstract Anaphylaxis is a clinical emergency, and recent reports suggest increased prevalence. A diverse set of primary genetic and environmental influences may confer susceptibility to anaphylactic reactions. Anaphylaxis presents diagnostic and therapeutic challenges. It often manifests with a broad array of symptoms and signs that might be similar to other diseases. The management of anaphylaxis consists of emergency treatment of acute episodes as well as preventive strategies to avoid recurrences. Treatment is complicated by its rapid onset and progression, presence of concurrent diseases or medications, and need for long‐term allergen avoidance. Health care professionals must be able to recognize the signs of anaphylaxis, treat an episode promptly and appropriately, and provide preventive recommendations. Recognizing the gaps in our understanding and management of anaphylaxis may help identify promising targets for future treatment and prevention and areas that require further study.

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Section: Management Of Anaphylaxismentioning

confidence: 99%

Anaphylaxis: past, present and future

Ben‐Shoshan

Clarke

2010

Allergy

157

140

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“…The use of a combination of skin prick tests, patch tests and oral challenges if skin tests are negative, appear to be more useful compared to SPT and IDT alone as negative skin tests may still result in positive challenges 75,76. Clindamycin desensitization has been reported in the literature in particular in HIV-infected individuals 77,78…”

Section: Clindamycin Allergymentioning

confidence: 99%

Update on the Management of Antibiotic Allergy

Thong

2010

Allergy Asthma Immunol Res

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Drug allergy to antibiotics may occur in the form of immediate or non-immediate (delayed) hypersensitivity reactions. Immediate reactions are usually IgE-mediated whereas non-immediate hypersensitivity reactions are usually non-IgE or T-cell mediated. The clinical manifestations of antibiotic allergy may be cutaneous, organ-specific (e.g., blood dyscracias, hepatitis, interstitial nephritis), systemic (e.g., anaphylaxis, drug induced hypersensitivity syndrome) or various combinations of these. Severe cutaneous adverse reactions manifesting as Stevens Johnson syndrome or toxic epidermal necrolysis (TEN) may be potentially life-threatening. The management of antibiotic allergy begins with the identification of the putative antibiotic from a detailed and accurate drug history, complemented by validated in-vivo and in-vitro allergological tests. This will facilitate avoidance of the putative antibiotic through patient education, use of drug alert cards, and electronic medical records with in-built drug allergy/adverse drug reaction prescription and dispensing checks. Knowledge of the evidence for specific antibiotic cross-reactivities is also important in patient education. Apart from withdrawal of the putative antibiotic, immunomodulatory agents like high-dose intravenous immunoglobulins may have a role in TEN. Drug desensitization where the benefits outweigh the risks, and where no alternative antibiotics can be used for various reasons, may be considered in certain situations. Allergological issues pertaining to electronic drug allergy alerts, computerized physician prescriptions and decision support systems, and antibiotic de-escalation in antimicrobial stewardship programmes are also discussed.

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“…These rashes typically vanished in 3–5 days; the medication was continued, and thus infection was the most probable cause. Desensitization with clindamycin was described in an immunocompromised patient 16 . Three of our patients continued the medication for 3 or more days after the appearance of the first skin symptoms of the systemic drug reaction: the intensity of the symptoms increased, suggesting a delayed‐type allergic reaction.…”

Section: Discussionmentioning

confidence: 98%