Drug allergy: A 2022 practice parameter update

Drug allergy: A 2022 practice parameter update - American Academy of Allergy, Asthma & Immunology (AAAAI)

This practice parameter provides an updated approach to the diagnosis and management of various drug reactions. Evidence has evolved since the previous drug allergy practice parameter1 and currently supports the ability to risk stratify most patients based on reaction phenotype. Evaluation of suspected drug allergy focuses on preferential use of drug challenges as opposed to skin testing in many circumstances. Clarification of drug allergy history is a valuable resource that allergist-immunologists provide to patients with shared decision making regarding testing and management options central to each evaluation. These parameters will help clinicians better understand how and when to use drug challenges, including consideration for 1-, 2-, or multistep challenges. While currently, 2-step challenges are required for reimbursement in the United States, the literature supports the use of single-step challenges in certain situations, and we are optimistic that third-party payers will reimburse this procedure in the future. A proactive approach to delabeling penicillin allergy as well as use of safe antibiotic alternatives for patients with proven penicillin allergy is emphasized. Approaches to diagnosis and management of nonpenicillin drug reactions are discussed in updated sections on cephalosporins, sulfonamides, fluroquinolones, macrolides, aspirin, chemotherapeutic agents, and biologics. This comprehensive resource provides consensus-based statements (CBSs) throughout, as well as detailed background and discussion to assist implementation into clinical practice.


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