In the patient above, any of the synthetic opioids(group 3) above would work. The structures of the group 3 compounds are sufficiently different that when given to a patient with a true allergy to group 1 or 2 compounds, cross-reactivity doesn’t happen. The natural and semi-synthetics have cross-reactivity. Hypersensitivity Reactions Allergic NHRs are noncross-reactive reactions, immunologically mediated based on immunoglobulin E (IgE) or T-cell response. Immunoassay-based screening methods provide high sensitivity but may be susceptible to specificity issues. Piperacillin-tazobactam Similarly, allergic reaction specific to tazobactam is rare but possible. Group 1 (the naturally occurring agents –opiates) and group 2 (the semi-synthetic) are structurally very similar to each other and should be avoided if there is a true allergy to any of the group 1 and 2 members. Consider penicillin skin-testing +/- amoxicillin challenge.
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