Michelle C Maciag1, Stephanie L Ward2, Amy E O'Connell3, Ana D Broyles4. 1. Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: michelle.maciag@childrens.harvard.edu. 2. Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio. 3. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts. 4. Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Hypersensitivity reactions (HSRs) to tetracyclines and the related compound, tigecycline, can limit the use of these medications and compromise optimal patient care. Despite this, there is little discussion in the literature describing the presentation of these reactions or guiding clinicians on the management of these reactions in adult and pediatric patients. OBJECTIVE: To describe the clinical features, optimal diagnostic approach, and management of HSRs to tetracyclines. METHODS: Patients with reactions to tetracyclines at our institution from 2011 to 2019 were identified by retrospective chart review. Skin testing protocols were designed for each antibiotic. Graded challenge and desensitization procedures were devised based on medical history, skin testing results when available, and need for readministration. RESULTS: The HSRs to tetracyclines, their workup, and management are described for 10 patients, aged 7 to 68 years. Our skin testing protocols for doxycycline, minocycline, and tigecycline described herein had good negative predictive value. When skin testing was negative and the initial reaction was not severe, graded challenge to the culprit drug was performed. Using the included procedures, 3 patients were desensitized to oral doxycycline, 3 to oral minocycline, and 2 to intravenous tigecycline. All the desensitizations were successful. CONCLUSION: Once identified, HSRs to tetracyclines can be further evaluated with skin testing and graded challenge and managed in appropriate cases with desensitization. These procedures can facilitate first-line therapy for patients who require tetracyclines but developed hypersensitivity reactions.
BACKGROUND:Hypersensitivity reactions (HSRs) to tetracyclines and the related compound, tigecycline, can limit the use of these medications and compromise optimal patient care. Despite this, there is little discussion in the literature describing the presentation of these reactions or guiding clinicians on the management of these reactions in adult and pediatric patients. OBJECTIVE: To describe the clinical features, optimal diagnostic approach, and management of HSRs to tetracyclines. METHODS:Patients with reactions to tetracyclines at our institution from 2011 to 2019 were identified by retrospective chart review. Skin testing protocols were designed for each antibiotic. Graded challenge and desensitization procedures were devised based on medical history, skin testing results when available, and need for readministration. RESULTS: The HSRs to tetracyclines, their workup, and management are described for 10 patients, aged 7 to 68 years. Our skin testing protocols for doxycycline, minocycline, and tigecycline described herein had good negative predictive value. When skin testing was negative and the initial reaction was not severe, graded challenge to the culprit drug was performed. Using the included procedures, 3 patients were desensitized to oral doxycycline, 3 to oral minocycline, and 2 to intravenous tigecycline. All the desensitizations were successful. CONCLUSION: Once identified, HSRs to tetracyclines can be further evaluated with skin testing and graded challenge and managed in appropriate cases with desensitization. These procedures can facilitate first-line therapy for patients who require tetracyclines but developed hypersensitivity reactions.
Authors: Patrick J Brennan; Tito Rodriguez Bouza; F Ida Hsu; David E Sloane; Mariana C Castells Journal: J Allergy Clin Immunol Date: 2009-12 Impact factor: 10.793
Authors: Jake Mann; Dennis Caruana; Evelyn Luo; Eric Gottesman; Nidhi Agrawal; Daniel Lozeau; Justina Hessel; Melissa Neumann; Sameer Khanijo; Zubair Hasan; Khizer Rizvi; Regina Gunther; Daniel Donovan; Derek Chan; Mary Lee-Wong; Anthony M Szema Journal: Cureus Date: 2022-08-12