Algorithm to identify patients at low risk

for penicillin/beta-lactam allergy

 

Did this patient have any symptoms of severe systemic or cutaneous adverse drug reaction?

These include ANY of the following:

  • Mucous membrane involvement

  • Skin desquamation

  • Vasculitis

  • Arthritis/arthralgia

  • Lymphadenopathy

  • Ongoing, unexplained fever

  • Evidence of kidney or liver involvement

  • Generalized pustulosis

Yes they did have some of these symptoms

No they did not

 

Clinical pearls:

The photos below demonstrate some common features of severe systemic or cutaneous adverse drug reactions. Review of these photos with your patient may be instructive.

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Conjunctivitis and desquamation in SJS

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Vasculitic rash with target lesions

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Lip involvement in SJS

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Acute generalized exanthematous pustulosis

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Lip involvement and desquamation in SJS

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Early or mild vasculitic rash

Note subtle purple center to rash. This should later become brown-green-yellow as the hemaglobin breaks down. All of these lesions should last >24 hours. If they last less than 24 hours, this is not a vasculitis, it is urticaria multiforme reaction, and although looks impressive, can be treated as urticaria, which is NOT on this list as a severe reaction

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Vasculitic rash and desquamation with SJS

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Resolving vasculitic rash

note the brown-green-yellow coloration to some of the lesions, as the hemaglobin breaks down. A vasculitic rash like this would last a minimum of 5 days. If patients report they had this kind of rash, and it lasted less than 24 hours, this was not a vasculitic rash, but was rather urticaria multiforme. Although this looks impressive, urticaria multiforme can be treated as urticaria, which is NOT on this list as a severe reaction