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Drug Allergy Diagnosis and Management of Drug Allergy in Adults, Children and Young People

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Drug Allergy Diagnosis and Management of Drug Allergy in Adults, Children and Young People National Clinical Guideline Centre NICE clinical guideline 183 Drug allergy Diagnosis and management of drug allergy in adults, children and young people Clinical guideline 183 Methods, evidence and recommendations September 2014 Final Commissioned by the National Institute for Health and Care Excellence Drug allergy Contents Disclaimer Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer. Copyright National Clinical Guideline Centre, 2014 Funding National Institute for Health and Care Excellence National Clinical Guideline Centre, 2014 Drug allergy Contents Contents Contents ............................................................................................................................................ 4 Guideline Development Group members .................................................................................... 8 NCGC technical team members .................................................................................................. 8 Co-optees ................................................................................................................................... 8 Acknowledgements ........................................................................................................................... 9 1 Introduction ............................................................................................................................. 10 2 Development of the guideline ................................................................................................. 12 2.1 What is a NICE clinical guideline? .................................................................................... 12 2.2 Remit .............................................................................................................................. 12 2.3 Who developed this guideline? ....................................................................................... 13 3 Methods .................................................................................................................................. 14 3.1 Developing the review questions and outcomes ............................................................. 14 3.2 Searching for evidence.................................................................................................... 16 3.2.1 Clinical literature search ..................................................................................... 16 3.2.2 Health economic literature search ...................................................................... 16 3.3 Evidence of effectiveness ................................................................................................ 17 3.3.1 Inclusion and exclusion criteria ........................................................................... 18 3.3.2 Methods of combining clinical studies ................................................................ 19 3.3.3 Type of studies ................................................................................................... 21 3.3.4 Appraising the quality of evidence by outcomes ................................................. 22 3.3.5 Grading the quality of clinical evidence............................................................... 23 3.3.6 Risk of bias ......................................................................................................... 23 3.3.7 Inconsistency...................................................................................................... 27 3.3.8 Indirectness ........................................................................................................ 27 3.3.9 Imprecision ........................................................................................................ 27 3.3.10 Evidence statements .......................................................................................... 28 3.4 Evidence of cost effectiveness ........................................................................................ 29 3.4.1 Literature review ................................................................................................ 29 3.4.2 Undertaking new health economic analysis ........................................................ 30 3.4.3 Cost-effectiveness criteria .................................................................................. 30 3.4.4 In the absence of economic evidence ................................................................. 31 3.5 Developing recommendations ........................................................................................ 31 3.5.1 Research recommendations ............................................................................... 32 3.5.2 Validation process .............................................................................................. 32 3.5.3 Updating the guideline ....................................................................................... 32 3.5.4 Disclaimer .......................................................................................................... 32 National Clinical Guideline Centre, 2014 4 Drug allergy Contents 3.5.5 Funding .............................................................................................................. 32 4 Algorithm ................................................................................................................................. 33 5 Guideline summary .................................................................................................................. 34 5.1 Key priorities for implementation ................................................................................... 34 Assessment .............................................................................................................................. 34 Documenting and sharing information with other healthcare professionals.............................. 35 Documenting new suspected drug allergic reactions................................................................. 35 Maintaining and sharing drug allergy information..................................................................... 35 Providing information and support to patients ......................................................................... 36 Providing information and support to people who have had specialist drug allergy investigations ................................................................................................................. 36 Non-specialist management and referral to specialist services.................................................. 36 General .................................................................................................................................... 36 Non-steroidal anti-inflammatory drugs (including selective cyclooxygenase 2 inhibitors) .......... 36 Beta-lactam antibiotics ............................................................................................................. 37 General anaesthesia ................................................................................................................. 37 5.2 Full list of recommendations ........................................................................................... 38 5.3 Key research recommendations ...................................................................................... 43 5.3.1 Designing systems for documenting drug allergy ................................................ 43 5.3.2 Communicating information about drug allergy.................................................. 43 5.3.3 Using selective cyclooxygenase 2 inhibitors in people with previous severe allergic reactions to non-selective non-steroidal anti-inflammatory drugs .......... 43 5.3.4 Oral antibiotic challenge for diagnosing antibiotic allergy in children .................. 43 6 Assessment .............................................................................................................................. 44 6.1 Review question: What is the clinical and cost effectiveness of clinical probability scores or algorithms in identifying or excluding drug allergies? ....................................... 44 6.2 Clinical evidence ............................................................................................................. 44 6.2.1 Algorithms.......................................................................................................... 44 6.2.2 Probability scores ............................................................................................... 52 6.2.3 Comparative studies ........................................................................................... 53 6.2.4 Most commonly used algorithm criteria ............................................................. 55 6.3 Economic evidence ......................................................................................................... 55 6.4 Evidence statements....................................................................................................... 56 6.5 Recommendations and link to evidence .......................................................................... 56 7 Measuring serum tryptase after suspected anaphylaxis .........................................................
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