I have also been following this post, but have not participated as of yet.
We need to remember there are essentially 3 types of rashes with a few
different outcomes that we all confuse (this is the way I think about it as
a non allergist).
1. there is the viral exanthem coincidental with the initiation of the
antibiotic.
2. there is the drug rash without hives or other anaphylactoid
reactions (typical timing of 7- 14 days after the first initiation of the
drug or 2-5 days after reinitiating a repeat exposure)
3. then there are the anaphylactoid reactions --- including hives
The first, is clearly the most common and hard to separate from the
second. I will frequently retry those kids (especially the kids who are an
antibiotics a lot) and I document in the medical record what it is that I
am doing and the parents agree. At times I will do it when they are well
with a single dose in the office. If they passit means they will NOT
anaphylaxis, although the may develop a drug rash.
The second .........if the rash was mild to moderate -- I saw, and I
really thought was a drug rash; I frequently do not retry. If the rash was
mild to moderate, was NOT seen, only a phone call......I frequently will
retry (again -- in the office)
The third......I would not touch unless they have testing and the allergist
tries the oral challenge.
mark
At 10:35 PM 2/23/2002, Dianna Tolen wrote:
I was following this string eagerly since I have very liberally re-
tried many "allergic" kids on the amoxil again in the practice I
inherited over the last 3 years. I have not had one kid have any
recurrence of the rash or other problems. I have however had a few
parents think I had lost my mind to suggest that they should try the
amoxil again, and one pharmacy refuse to fill a penicillin
prescription since they had it on file that the kid was "allergic".
My question to you all is: when have you felt it was NOT safe to
retry a child again? Was it the type of rash/reaction (which is not
always remembered correctly anyway by parents), or the length of time
that has elapsed since the original incident, or the age of the
child?
Anyone have any bad outcomes? Do you document in the chart that the
parent is agreeing to take this risk (along with yourself)?
Dianna Tolen, M.D.
Kids First Pediatric Care
Canfield, Ohio