Referral criteria if drug allergy (allergic)

Non-specialist management and referral to specialist services

General

Refer people to a specialist drug allergy service if they have had:

• a suspected anaphylactic reaction
• or a severe non-immediate cutaneous reaction (for example, drug reaction with eosinophilia and systemic symptoms [DRESS], Stevens-Johnson Syndrome, toxic epidermal necrolysis)

Non-steroidal anti-inflammatory drugs (including selective cyclooxygenase 2 inhibitors)

• for people who have had a mild allergic reaction to a non-selective NSAID but need an anti-inflammatory:
  • discuss the benefits and risks of selective cyclooxygenase 2 (COX-2) inhibitors (including the low risk of drug allergy)
  • consider introducing a selective COX-2 inhibitor at the lowest starting dose with only a single dose on the first day
• refer people who need treatment with an NSAID to a specialist drug allergy service if they have had a suspected allergic reaction to an NSAID with symptoms such as anaphylaxis, severe angioedema or an asthmatic reaction.
  • be aware that people with asthma who also have nasal polyps are likely to have NSAID-sensitive asthma unless they are known to have tolerated NSAIDs in the last 12 months

Beta-lactam antibiotics

• refer people with a suspected allergy to beta-lactam antibiotics to a specialist drug allergy service if they:
  • need treatment for a disease or condition that can only be treated by a beta-lactam antibiotic or
  • are likely to need beta-lactam antibiotics frequently in the future (for example, people with recurrent bacterial infections or im/mune deficiency)

General anaesthesia

• refer people to a specialist drug allergy service if they have had anaphylaxis or another suspected allergic reaction during or immediately after general anaesthesia.

Reference:

• NICE (September 2014). Drug allergy: diagnosis and management of drug allergy in adults, children and young people