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PCN Allergy

Bryan Hayes, PharmD and Mike Weinstock, MD
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No me gusta!

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Bryan and Mike discuss the incidence and repercussions of penicillin and cephalosporin allergy histories, the true nature of cross-reactivity, and the approach to evaluation and management in the urgent care setting.

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David S. -

Hi guys! If the side chains dictate the allergic response, is it okay to use a 3rd+ generation cephalosporin in someone with a high-risk reaction to PCN/amox or is that a bridge we aren’t willing to cross yet? Thanks!

Mike W., MD -

Based on the data we now have, this is usually ok. However, for 'high-risk reactions' we still recommend going through the process of thorough allergy history and potential test dose or POC skin test. The JAMA article outlines a good approach that can be followed in the ED or Urgent Care. In the minority of patients who have true allergies, they are more likely to have independent additional allergies, though the risk of reaction with this specific scenario is low.

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Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP
Assistant Professor of Emergency Medicine, Harvard Medical School
Attending Pharmacist, EM & Toxicology, MGH
President, American Board of Applied Toxicology (ABAT)
Twitter: @PharmERToxGuy
PharmERToxGuy.com

Ian L., Dr -

There are alternative antibiotics in a patient that had anaphylaxis for the vast majority of Out patient infections eg in Australian Therapeutic Guidelines Guidelines for otitis media : trimethoprim and sulfamethoxazone is recommended if there has been a non severe or severe immediate hypersensitivity reaction "Electronic" .Australian Therapeutic guidelines December 2019 Edition .Antibiotics Cefuroxamine the cephalosporin but without the Amoxycillin side change is only recommended for non severe delayed hypersensitivity .
Also I would keep a patient in the clinic for half an hour -one hour with adrenalin available -if there is a past history of anaphylaxis - as these patients seem hyperallergic .

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Urgent Care RAP - January 2020 Written Summary 2 MB - PDF

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