In the particular situation Michael quotes, with a non-urticarial
exanthematous rash associated with Amoxil, I have been telling parents for
years that this is an adverse reaction to Amoxil, but not an allergic
reaction. When the rash appears while the child is still taking the
medicine, I tell the parent to complete the Amoxil course, since the rash
will go away in 3 or 4 days whether the medicine is continued or not. For
subsequent illnesses, I prescribe penicillins as if no reaction had
occurred. In the dim dark recesses of my knowledge, I remember reading that
this rash is not IgE-mediated, so there should be no additional risk of
subsequent anaphylaxis, but I cannot give you the reference. (Pediatrics in
Review comes to mind, though).
So far, no problems with this advice.
David Arkin, MD
Richmond, VA
From: Michael Sachs <>
Reply-To: Michael Sachs <>
To:
Subject: Re: The Infamous "Amoxil Rash"
Date: Sun, 17 Feb 2002 14:12:37 -0800
In a message dated 2/14/2002 1:40:45 PM Eastern Standard Time,
writes:
> Anyone have any information on the infamous "Amoxil (amoxicillin)
rash"?
At 04:31 PM 2/17/02 -0500, wrote:
No data, but I certainly see it. That's why I ask lots of questions when
parents tell me their child is allergic to something. You really have to
find out what kind of reaction they had. Many tell me they vomited, or
had
some diarrhea, or something else like that. Rashes are tougher, because
they
don't always remember what it looked like or whether it itched. If I'm
not
really sure, I let them know that testing is available for penicillin
allergy.
Moshe Adler, MD
I seem to recall reading somewhere that 70-80% of people who report a
penicillin allergy actually are not allergic.
Sometimes when I'm pretty confident that a non-urticarial rash is likely
one of these idiosyncratic Amoxil rashes or maybe a non-specific viral
exanthem I'll try Amoxil again at some point in the future. I've rarely
seen the rash duplicated on a subsequent course of Amoxil.
So here's a question back to the list: If a child has had a non-severe,
non-specific, non-systemic, non-urticarial rash associated with Amoxil in
the past, is there likely to be a significant risk of anaphylaxis with
trying another course before doing formal skin or RAST testing? Any
opinions?
Michael Sachs, M.D.
General Pediatrician
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