Drug allergy to antibiotics. Part II. Management of patients with respiratory diseases and allergy to β-lactam antibiotics, diagnosis of hypersensitivity

The high frequency of drug allergy cases determines the importance of identifying patients with a high risk of its development on antibiotics, primarily penicillins and cephalosporins, since it is drugs of these classes in real clinical practice that are most often prescribed by doctors of various specialties as initial empiric antibacterial therapy for patients with upper and lower respiratory infections ways. The key to the rapid detection of persons from the high-risk group of developing hypersensitivity reactions to medicinal products at an outpatient appointment is the collection by a doctor of an allergy history of each patient to whom it is planned to prescribe one or another drug, especially an antibiotic for bacterial respiratory infections. If a drug allergy to antibiotics or other drugs is suspected, the patient should be referred to an allergist or pediatric allergist for consultation. Traditionally, the diagnostic approach in case of drug allergy involves the use of the following research methods: 1) clinical and anamnestic data; 2) skin tests with medicinal products (in vivo tests); 3) laboratory tests with them (in vitro tests); 4) provocative tests with drugs (if necessary). It is not necessary to make a diagnosis of drug allergy only on the basis of laboratory tests, a large part of which is not validated in Ukraine, to condemn patients to a life-long «label» of such a diagnosis based only on the data of laboratory tests, and to deprive them of the opportunity to be effectively treated with drugs that are not causally significant. Macrolides can be a rational alternative to β-lactams in patients with respiratory infections and drug allergy.