Approach to the patient with multiple antibiotic sensitivities

Allergists sometimes are asked to evaluate patients who have experienced multiple adverse drug reactions. By the time the patient reaches the allergist, the referring physician, as well as the patient, often are frustrated. Each seeks a quick and simple answer regarding the particular drugs the patient may safely receive. Unfortunately, however, in most instances, simple answers cannot be given. Currently we have limited knowledge of the mechanisms and of the clinically-relevant drug metabolites responsible for many of the reactions demonstrated and, for these reasons, we have few valid diagnostic tests that are able to provide clear-cut answers for our patients who present with multiple drug "allergies." Despite these limitations, using accurate and complete historical information along with limited diagnostic testing, logical and practical management approaches can be devised. In addition, due to new exciting data that are being generated from basic research studies in drug allergy, the mechanisms underlying the immunopathology of many drug reactions are becoming more clear. Through the acquisition of scientific information of this type, it is hoped that valid diagnostic tools soon will be developed so that definitive answers, desired by both the patient and the referring physician, can be provided.