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Publications

Journal Article Review Epublish

PubMed: 42835668 DOI: 10.1016/j.waojou.2026.101467

Standards for practical management of drug hypersensitivity reactions to intravenous drugs and proactive early allergy involvement before referral: A WAO Statement.

World Allergy Organ J 19(10):101467

Authors: Ricardo Madrigal-Burgaleta, Emilio Alvarez-Cuesta, Knut Brockow, Jean-Christoph Caubet, Lene H Garvey, Antonieta Guzman-Melendez, Marina Labella Alvarez, Lina Mayorga, Paula Vazquez-Revuelta, Ignacio J Ansotegui, Marina Attanasi, Marcelo Vivolo Aun, Joan Bartra, Sevim Bavbek, Maria Pilar Berges-Gimeno, Lorena Bernal-Rubio, Cosmin Boteanu, Lucrecia Bustamante, Carlo Caffarelli, Timothy G Chow, Bryan N Fernandes, Pedro Giavina-Bianchi, David Khan, Semanur Kuyucu, Jose Julio Laguna, Jonathan Lambourne, Lily Li, Susana Marinho, Francesca Mori, Allison E Norton, Valeria Palma Pino, Claudio A S Parisi, Hae-Sim Park, Elizabeth Powell, Eva Rebelo Gomes, Antonino Romano, Marek Sanak, Rik Schrijvers, Emilio Solano-Solares, Luciana Kase Tanno, Rocco Luigi Valluzzi, Rosalaura Villarreal-Gonzalez, Timothy J Watts, Andrew A White, Masao Yamaguchi

Affiliations

  • Allergy & Asthma Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
  • Academic in Allergy and Immunology, Allergy Division, Former Head, Ramon & Cajal University Hospital, Madrid, Spain.
  • Department of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine and Health, Munich, Germany.
  • Pediatric Allergy Unit, Department of Woman, Child, and Adolescent, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
  • Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
  • Department of Clinical Medicine, University of Copenhagen, Denmark.
  • Section of Immunology, HIV and Allergy, Department of Medicine, Clinical Hospital University of Chile, Chile.
  • Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain.
  • Allergy Unit and Research Labratory, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Málaga, Spain.
  • Drug Hypersensitvity & Desensitisation Centre, Catalan Institute of Oncology (ICO), Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain.
  • Hospital Quironsalud, Bizkaia, Bilbao-Erandio, Spain.
  • Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy.
  • Faculdade Israelita de Ciências da Saúde Albert Einstein School of Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Clinical Immunology and Allergy and Immunology Division, University of São Paulo, São Paulo, Brazil.
  • Department of Allergy, Hospital Clinic Barcelona, Universitat de Barcelona (UB), Barcelona, Spain.
  • Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
  • Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
  • Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey.
  • Allergy Division, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain.
  • Allergy Unit, Allergo- Anesthesia Unit, University Hospital of Cruz Roja and Faculty of Medicine and Biomedicine, Alfonso X El Sabio University, Madrid, Spain.
  • Hospital Italiano of Buenos Aires, Argentina.
  • Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Azienda Ospedaliero-Universitaria, Università di Parma, Italy.
  • Division of Allergy and Immunology, Departments of Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.
  • University of São Paulo, Brazil.
  • Dept. of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
  • Department of Paediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey.
  • Department of Infection, Barts Health NHS Trust, London, United Kingdom.
  • Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle WA, United States.
  • Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom.
  • Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
  • Pediatric Allergy & Immunology, Vanderbilt University, Nashville, TN, United States.
  • Clinical Hospital, University of Chile, Santiago, Chile.
  • Hospital Italiano de Buenos Aires, Argentina.
  • Department of Allergy and Clinical Immunology, Ajou University School of Medicine, South Korea.
  • Evelina London Children's Hospital. Guy's and St Thomas' NHS Foundation Trust, Children's Allergy Service, United Kingdom.
  • Allergy and Clinical Immunology Department, Centro Hospitalar Universitário Santo António, Porto, Portugal.
  • BIOS S.p.A. Società Benefit, Rome, Italy.
  • Jagiellonian University Medical College, Kraków, Poland.
  • KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium.
  • Allergy and Immunology, Mediclinic Parkview Hospital, Dubai, United Arab Emirates.
  • Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France.
  • Desbrest Institute of Epidemiology and Public Health, UMR 1318, University of Montpellier-INSERM, France.
  • Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
  • Oncology Service, University Hospital "Dr. José Eleuterio González", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico.
  • Department of Respiratory Medicine & Allergy, Homerton Healthcare NHS Foundation Trust, London, United Kingdom.
  • Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, United States.
  • Division of Respiratory Medicine, Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan.

Abstract

Hypersensitivity reactions to intravenous therapies-including antibiotics, chemotherapeutics, biologics, anesthesia agents, and contrast media-pose significant challenges in acute care settings. These reactions often occur outside the purview of allergy specialists, leading to delays in recognition, suboptimal management, and inconsistent documentation. This article underscores the imperative for proactive, multidisciplinary collaboration to enhance patient safety and treatment continuity. We examine the spectrum of intravenous reactions, including anaphylaxis, highlighting the pivotal role of allergists in both acute intervention and long-term care planning. Emphasis is placed on the development of standardized protocols, the establishment of inpatient allergy consult teams, and the implementation of penicillin allergy delabeling strategies. Supplemental materials provide real-world examples from leading institutions that have successfully integrated multidisciplinary approaches, demonstrating improved outcomes through coordinated care. By proactively engaging in the creation of safety protocols, referral pathways, and joint models of care, allergy specialists can contribute significantly to safer patient environments, even before reactions occur, ensuring timely diagnosis, effective management, and optimal outcomes.

MeSH

Safety, Pharmaceutical Preparations, Hypersensitivity, Drug Hypersensitivity, Therapeutics, Allergy