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Hypersensitivity to tetracyclines: Skin testing, graded challenge, and desensitization regimens
Michelle C Maciag1, Stephanie L Ward2, Amy E O'Connell3
1Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Summary
Hypersensitivity reactions (HSRs) to tetracyclines can be diagnosed using skin testing and managed with graded challenges or desensitization. These methods enable patients with tetracycline allergies to receive necessary treatments safely.
Area of Science:
- Allergy and Immunology
- Pharmacology
- Dermatology
Background:
- Hypersensitivity reactions (HSRs) to tetracyclines and tigecycline can impede treatment.
- Limited literature exists on the presentation and management of these HSRs in diverse patient populations.
Purpose of the Study:
- To outline the clinical characteristics, diagnostic strategies, and management approaches for HSRs to tetracyclines.
Main Methods:
- Retrospective chart review of patients experiencing tetracycline reactions (2011-2019).
- Development of skin testing protocols for doxycycline, minocycline, and tigecycline.
- Implementation of graded challenges and desensitization procedures based on reaction severity and need for re-administration.
Main Results:
- Ten patients (ages 7-68) with HSRs to tetracyclines were analyzed.
- Skin testing demonstrated good negative predictive value for doxycycline, minocycline, and tigecycline.
- Successful desensitization was achieved in 3 patients for oral doxycycline, 3 for oral minocycline, and 2 for intravenous tigecycline.
Conclusions:
- HSRs to tetracyclines can be effectively diagnosed via skin testing and managed with graded challenge or desensitization.
- These procedures allow for the safe administration of first-line tetracycline therapy in hypersensitive patients.
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