Management of patients allergic to antimicrobial drugs

Allergic reactions to antimicrobial drugs cause significant morbidity in approximately 1% of treated patients. Those who express allergic reactions to antimicrobial drugs or who are at increased risk of reacting also can present difficult diagnostic and management problems. Recent studies suggest that patients who have expressed allergic reactions to antimicrobial drugs in the past or who are the offspring of antimicrobial drug-allergic parents are at increased risk of antimicrobial drug allergy. This propensity to antimicrobial drug allergy is not restricted to specific classes of drug or to specific patterns of allergic reactions. The concept that antimicrobial drug allergy often is a recurrent disease rather than an isolated event has generated new approaches to the comprehensive management of high-risk patients. This concept also has suggested new areas for investigation that may provide fundamental new insights into why some persons express immune responses to haptens and others do not.