Drug allergy: A 2022 practice parameter update - 05/12/22

Doi : 10.1016/j.jaci.2022.08.028

David A. Khan, MD ^a, Aleena Banerji, MD ^b, Kimberly G. Blumenthal, MD, MSc ^b, Elizabeth J. Phillips, MD ^c,^d, Roland Solensky, MD ^e, Andrew A. White, MD ^f, Jonathan A. Bernstein, MD ^g, Derek K. Chu, MD, PhD ^h,^i,^j, Anne K. Ellis, MD ^k, David B.K. Golden, MD ^l, Matthew J. Greenhawt, MD ^m, Caroline C. Horner, MD ⁿ, Dennis Ledford, MD ^o,^p, Jay A. Lieberman, MD ^q, John Oppenheimer, MD ^r, Matthew A. Rank, MD ^s, Marcus S. Shaker, MD, MSc ^t, David R. Stukus, MD ^u,^v, Dana Wallace, MD ^w, Julie Wang, MD ^x
^a Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
^b Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
^c Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia
^d Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
^e Corvallis Clinic, Oregon State University/Oregon Health Science University College of Pharmacy, Corvallis, Ore
^f Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
^g Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
^h Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
ⁱ Department of Medicine, McMaster University, Hamilton, Ontario, Canada
^j The Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada
^k Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
^l Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
^m Food Challenge and Research Unit Section of Allergy and Immunology, Children’s Hospital Colorado University of Colorado School of Medicine, Aurora, Colo
ⁿ Department of Pediatrics, Division of Allergy Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
^o Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
^p James A. Haley Veterans Affairs Hospital, Tampa, Fla
^q Division of Allergy and Immunology, The University of Tennessee Health Science Center, Memphis, Tenn
^r Division of Allergy, Rutgers New Jersey Medical School, Rutgers, NJ
^s Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
^t Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
^u Division of Allergy and Immunology, Nationwide Children’s Hospital, Columbus, Ohio
^v The Ohio State University College of Medicine, Columbus, Ohio
^w Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
^x Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY

Chief Editor(s):
David A. Khan, MD, David B.K. Golden, MD, Marcus Shaker, MD, MSc, David R. Stukus, MD

Workgroup Contributors:
David A. Khan, MD, Aleena Banerji, MD, Kimberly G. Blumenthal, MD, Elizabeth J. Phillips, MD, Roland Solensky, MD, Andrew A. White, MD

Joint Task Force on Practice Parameters Reviewers:
Jonathan A. Bernstein, MD, Derek K. Chu, MD, PhD, Anne K. Ellis, MD, David B.K. Golden, MD, Matthew J. Greenhawt, MD, Caroline C. Horner, MD, Dennis Ledford, MD, Jay A. Lieberman, MD, John Oppenheimer, MD, Matthew A. Rank, MD, Marcus S. Shaker, MD, Msc, David R. Stukus, MD, Dana Wallace, MD, Julie Wang, MD

Abbreviations used : 95% Crl, AERD, AGEP, alpha-gal, CBS, dIDT, DIHS, DRESS, FDA, FDE, GRADE, HSR, ICIs, irAEs, JTFPP, MDE, NPV, NSAID, OR, PD-1, PD-L1, PEG, PPL, PPV, PT, SCARs, SJS, SPT, SSLRs, TEN, TKIs, TMP-SMX

Plan

Table of Contents

Preface

Glossary

What’s new and what’s different

Executive summary

Classification of drug allergies

Diagnostic tests

Antibiotic allergy

NSAID hypersensitivity

Cancer chemotherapeutics

Immune checkpoint inhibitors

Biologics

Excipients

Methods and Overview of the Practice Parameter Development Process

Diagnostic Testing Updates

Drug challenges

Testing for delayed HSRs

Pharmacogenomics

Antibiotic Allergy Updates

Beta-lactams

Sulfonamides

Fluoroquinolones and macrolides

Fluoroquinolones

Macrolides

NSAID Hypersensitivity Updates

Aspirin/NSAID hypersensitivity phenotypes

Aspirin-exacerbated respiratory disease

NSAID-exacerbated cutaneous disease

Multiple NSAID-induced urticaria and angioedema

Single NSAID-induced urticaria, angioedema, and anaphylaxis

Other NSAID hypersensitivity subtypes

Common NSAID hypersensitivity clinical scenarios

NSAID hypersensitivity in children

Clopidogrel hypersensitivity

Cancer Chemotherapeutic Hypersensitivity

Platins

Taxanes

Asparaginase

Tyrosine kinase inhibitors

Adverse Reactions to ICIs

Biologic Hypersensitivity

	Reprints: Joint Task Force on Practice Parameters liaison: Rebecca Brandt, American Academy of Allergy, Asthma & Immunology, 555 E. Wells Street, Suite 1100, Milwaukee, WI 53202. E-mail: rbrandt@aaaai.org; JTFPP.allergy@gmail.com
	Previously published practice parameters and guidelines of the Joint Task Force on Practice Parameters are available at http://www.allergyparameters.org; www.AAAAI.org, and www.ACAAI.org.
	Disclosure of potential conflict of interest: The Joint Task Force on Practice Parameters (JTFPP) members and workgroup members’ conflict of interest disclosure forms can be found at www.allergyparameters.org. D. Khan has received financial support from UpToDate and Aimmune; serves on the Board of Directors of the American Academy of Allergy, Asthma & Immunology (AAAAI), as the American College of Asthma, Allergy, and Immunology (ACAAI) Chair of Literature Review, as Co-Chair of Conjoint Board Review, and as the Texas Allergy, Asthma, and Immunology Society Chair of Meetings Committee; and is Associate Editor of the Journal of Allergy and Clinical Immunology In Practice. A. Banerji has received financial support from Kalvista, Pharvaris, CSL, Takeda, and Biocryst. J. Bernstein has received financial support from Teledoc/Advanced Medical, Inspirotec, PulmOne, Medpace, Sanofi-Regeneron, AstraZeneca, Merck, Optinose, Takeda, CSL Behring, Biocryst, Pharming, Kalvista, Ionis, Novartis, Genentech, the National Institutes of Health (NIH), Taylor Francis, and INEOS; is Editor in Chief of the Journal of Asthma, INEOS’s Medical Immunosurveillance Director, Vice Chair and Lectureship Chair of the AAAAI Foundation, Chairman of Allergists for Israel (AFI), ACAAI Asthma Chair, Scientific Chair, and Young Investigator Award Chair; and serves on the Board of Directors and Scientific Committee of Interasma as well as the Board of Directors for the AAAAI and World Allergy Organization. K. Blumenthal has received financial support through UpToDate and research grants through NIH. D. Chu has received research grants through the Canadian Allergy, Asthma, and Immunology Foundation and AAAAI Foundation. A. Ellis has received financial support from Mylan, Bausch Health, Pfizer, ALK-Abelló, Medexus, Aralez, Novartis, AstraZeneca, Bayer LLC, and Regeneron; and serves on the Board of Directors of the Canadian Allergy Society of Allergy and Clinical Immunology. D. Ledford has received financial support from ALK-Abelló, Boehringer Ingelheim, AstraZeneca, BioCryst, AAAAI, Informa, UpToDate, Genentech, GSK, and Sanofi-Regeneron. D. Golden has received financial support from Aquestive, ALK-Abelló, Genentech, Novartis, Thermo Fisher, Allergy Therapeutics, Regeneron, and UpToDate; and serves on the Editorial Boards for The Journal of Allergy and Clinical Immunology: In Practice and Annals of Allergy, Asthma, and Immunology. M. Greenhawt has received financial support from Allergy Therapeutics, Allergenis, Sanofi-Regeneron, Pfizer, US World Meds, Prota, Aquestive, Novartis, ACAAI, DBV Technologies, and Intrommune; is supported by the Agency of Healthcare Research and Quality; has served on the Advisory Board of International Food Protein Induced Enterocolitis Syndrome Association, the Asthma and Allergy Foundation of America, and the National Peanut Board; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology. C. Horner has served as Committee Chair for the AAAAI Asthma Diagnosis and Treatment Interest Section, Interest Section Coordinating Committee, and In-Training Exam Coordinating Committee. J. Lieberman has received financial support from the ACAAI, DBV Technologies, Novartis, Genentech, Aimmune, Regeneron, and ALK-Abelló; is Associate Editor of the Annals of Allergy, Asthma, and Immunology, Chair for the ACAAI Food Allergy Committee, Vice Chair for the ACAAI Annual Meeting Program Committee, Board Member for the American Board of Allergy and Immunology, and Medical Director for Food Allergy Alliance of the MidSouth. J. Oppenheimer has received financial support from Aquestive, Aimmune, GSK, Amgen, AstraZeneca, Regeneron, and UpToDate; has received grant support from NIH; and serves as an Executive Editor for Annals of Allergy, Asthma, and Immunology. E. Phillips has received financial support from Biocryst, Regeneron, Vertex, UpToDate, and Janssen; and research grant support from NIH and National Health and Medical Research Council Australia. M. Rank has received financial support from the ACAAI, NIH, Flinn Foundation, and Levin Family Foundation; has served as Chair of the AAAAI Health, Equity, Technology, and Quality Interest Section; and is Research Director of the Phoenix Children’s Hospital Breathmobile. M. Shaker is Associate Editor for Annals of Allergy, Asthma, and Immunology and Editorial Board Member for the Journal of Allergy and Clinical Immunology: In Practice; and has participated in research that has received funding from DBV Technologies. R. Solensky has received research grant support from ALK-Abelló and Staller-Greer. D. Stukus has received financial support from Before Brands, DBV Technologies, Novartis, Kaleo, Integrity CE, the American Academy of Pediatrics, and ACAAI; has served as Committee Chair for the AAAAI and ACAAI; is an advisor for the Asthma and Allergy Foundation of America, Co-Chair for North American Pediatric Asthma and Allergy Conference Annual Meeting Planning Committee, and Associate Editor for Annals of Allergy, Asthma, and Immunology; serves on the Board of Regents for ACAAI; and is the Social Media Editor for AAAAI. J. Wang has received financial support from ALK-Abelló, Regeneron, DBV Technologies, Aimmune, and Jubilant HollisterStier; is an UpToDate author; serves on the Executive Committee of the American Academy of Pediatrics Section on Allergy and Immunology; and serves as Chair of the AAAAI Anaphylaxis, Dermatitis, Drug Allergy Interest Section and as Vice Chair of the AAAAI Annual Meeting Program Committee. A. White has received financial support through Genentech, GSK, Blueprint Pharmaceuticals, Optinose, Sanofi-Regeneron, and AstraZeneca; and serves as a Board Member for the Western Society of Allergy, Asthma, and Immunology. D. Wallace declares that she has no relevant conflicts of interest.