Hypersensitivity Reactions Board Exam Review Questions, Free CME Quiz
This week's Med-Challenger free CME quiz - Hypersensitivity Reactions - the quick quiz covers the diagnosis of serum sickness, the correct initial route and dosage of epinephrine for anaphylaxis, diagnosis of aspirin-exacerbated respiratory disease, and the differences between a type IV hypersensitivity reaction to amoxicillin and a benign "amoxicillin rash."
A free sample Hypersensitivity Reactions question included below. The full Hypersensitivity Reactions CME quiz is free online for a limited time. You can earn AMA CME credit - and now you can earn ANCC contact hours as well! Play now.
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Here's this week's sample CME board review question on hypersensitivity reactions:
A 6-year-old girl presents with a non-pruritic rash that involves the face, trunk, back, and extremities.
She has completed 9 days of a 10-day course of amoxicillin for otitis media.
Treatment includes which of the following?
Avoidance of penicillins in the future
See the Answer:
The correct answer is:
Discuss the differences between a type IV hypersensitivity reaction to amoxicillin and a benign "amoxicillin rash."
People often mistakenly think they are allergic to penicillin, even when they aren’t.
This is a diffuse erythematous macular rash seen after amoxicillin administration, especially if the patient has undiagnosed mononucleosis or another viral syndrome that is inadvertently treated with amoxicillin.
This so-called “amoxicillin rash” does not represent an allergic reaction and should not prevent patients from completing the current course or receiving penicillins in the future. It will resolve spontaneously in 7-10 days and does not require treatment. It will not recur except perhaps if a future viral infection is again inadvertently treated with amoxicillin.
The absence of pruritus and angioedema in a well appearing, afebrile child renders the diagnosis of “benign amoxicillin rash” more likely than “allergic reaction to amoxicillin” (especially in the context of a positive mono test). By contrast, the urticarial rash of an amoxicillin allergic reaction is pruritic and has angioedema (raised rash - see figures).
The "amoxicillin rash" was first noticed in the 1960s in children who were being treated with ampicillin for mono, according to the Journal of Pediatrics. The rash was reported to have developed in almost every child, between 80 and 100 percent of cases.
Benign maculopapular reaction to amoxicillin in a well child without fever
Urticaria with angioedema within the lesions
Chovel-Sella A, et al. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis. Pediatrics. 2013 May;131(5):e1424-7. doi: 10.1542/peds.2012-1575. Epub 2013 Apr 15. PMID: 23589810
Harvard Health Publishing. Do You Really Have a Penicillin Allergy? Accessed on December 28, 2021 at National Institutes of Health.
Immediate and non-immediate allergic reactions to amoxicillin present a diagnostic dilemma: a case series. Accessed on December 28, 2021
Mayo Clinic. Penicillin Allergy. Accessed on December 28, 2021
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