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When any patient uses a medicine, it has the ability to cause a noxious and unintended response known as an ‘adverse drug reaction’ (ADR). A drug allergy is defined as an ADR with specific clinical features compatible with an immunological mechanism that re-occurs on re-exposure to that offending drug. Sometimes, it can be a challenge to decide from the clinical history alone as to whether a drug reaction is allergic or not without the need for further investigations.
Information about current guideline
In September 2014, the National Institute for Health and Care Excellence (NICE) published a guideline entitled ‘Drug allergy: diagnosis and management of drug allergy in adults, children and young people’.1 This was developed due to variation in provision of care for people with a suspected drug allergy and to optimise best practice advice on the diagnosis, documentation and communication of drug allergy. Our focus here will be on the recommendations for children and young people.
The British Society for Allergy and Clinical Immunology (BSACI) guidelines for the management of drug allergy were published in 20082 with an update which can be found in box 1. The European Association of Allergy and Clinical Immunology (EAACI) also published an international consensus of drug allergy in February 2014.3 Both of these look at the management of drug allergy within the secondary-care and tertiary-care setting, including details on specialist investigations, in contrast to the NICE guideline, which is aimed at all health professionals who review and manage children including in primary care. Differences between these guidelines are demonstrated in table 1.
Link to NICE guideline: http://www.nice.org.uk/guidance/cg183/resources/guidance-drug-allergy-diagnosis-and-management-of-drug-allergy-in-adults-children-and-young-people-pdf
Link to BSACI guideline: http://www.bsaci.org/guidelines/drug-allergy; http://www.bsaci.org/guidelines/beta-lactam-allergy
Link to EAACI position statements: http://onlinelibrary.wiley.com/doi/10.1111/all.12350/full;http://www.eaaci.org/rganisation/eaaci-interest-groups/ig-on-drug-allergy/about-us.html
What do I need to know?
Be aware that the reaction is less likely to be caused by a drug …
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