When managing a patient who has experienced an adverse drug reaction (ADR) to a medication they are currently taking, the first step is to assess the reaction carefully by taking a detailed history and performing a clinical examination to determine the likelihood that the drug caused the reaction and to classify the type of reaction (immediate or non-immediate, allergic or non-allergic) NICE CG183. If drug allergy is suspected, consider stopping the suspected drug immediately and advise the patient to avoid it in the future NICE CG183. Treat any acute symptoms as needed, and for severe reactions such as anaphylaxis or severe cutaneous adverse reactions (e.g., Stevens-Johnson syndrome, DRESS), urgent hospital referral is required NICE CG183.
Document the suspected drug allergy thoroughly in the patient’s medical records, including the drug name, nature of the reaction, and any investigations performed NICE CG183. Provide the patient with clear, structured written information about their suspected drug allergy, including drugs or drug classes to avoid and advice to check with a pharmacist before taking any over-the-counter medicines NICE CG183. Advise patients to carry this information at all times and share it with healthcare professionals when prescribed or administered any medication NICE CG183.
Involve a pharmacist with relevant clinical expertise to support medicines optimisation and ensure safe future prescribing NICE NG5. Referral to a specialist drug allergy service is recommended if the patient has had a suspected anaphylactic reaction or a severe non-immediate cutaneous reaction NICE CG183. Specialist assessment may include allergy testing to confirm or exclude the diagnosis and to identify safe alternative drugs NICE CG183.
Recent literature on managing hypersensitivity reactions to specific drug classes, such as anti-tuberculosis drugs, supports this approach by emphasizing early recognition, withdrawal of the offending agent, symptomatic treatment, and specialist referral for complex cases Bermingham et al. 2022. This aligns with the UK guidelines but highlights the importance of tailored management depending on the drug involved and the reaction severity.
In summary, management involves prompt recognition, stopping the suspected drug, symptom treatment, documentation, patient education, pharmacist involvement, and specialist referral when indicated NICE NG5,NICE CG183 Bermingham et al. 2022.