FIGURE 6.

Stepwise approach to the evaluation and treatment of patients with type I IgE-mediated drug allergy (see Table 1). This approach cannot be used in the case of severe reactions, including SJS, TEN, DRESS syndrome, nephritis, hepatitis, and hemolysis. Adapted from Turvey SE, Cronin B, Arnold AD, Dioun AF. Antibiotic desensitization for the allergic patient: 5 years of experience and practice. Ann Allergy Asthma Immunol. 2004;92(4): p. 430 and Dioun AF. Management of multiple drug allergies in children. Curr Allergy Asthma Rep. 2012;12(1): p. 81.

See Figs 1–5 for cross reactivity. ^aPursuing skin testing is dependent on negative predictive value of testing and reagent dependent. Consider going straight to challenge if reaction was mild and inconsistent with IgE mediated drug allergy. ^b Consider graded challenge for milder reactions or desensitization for more severe reactions. ^cConsider graded challenge for milder reactions. ^dConsider desensitization regardless of skin test, particularly if index reaction was severe.