Drug history immunizations

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Because immunotherapy is expensive, has potential risks, and requires a major time commitment from patients, it should only be considered in select patients. Good candidates include patients who have a strong history of severe symptoms unsuccessfully controlled by avoidance and pharmacotherapy and patients who have been unable to tolerate the adverse effects of drug therapy. Poor candidates include patients with medical conditions that would compromise the ability to tolerate an anaphylactic-type reaction, patients with impaired immune systems, and patients with a history of nonadherence to therapy. 

Lack of previous exposure is not the same as lack of history of previous exposure, and first dose reactions are among the most dramatic. Exposure is not necessarily medical, e.g. penicillins may occur in dairy products following treatment of mastitis in cows (despite laws to prevent this), and penicillin antibodies are commonly present in those who deny ever having received the drug. Immune responses to drugs may be harmful (allergy) or harmless the fact that antibodies are produced does not mean a patient will necessarily respond to re-exposure with dinical manifestations most of the UK population has antibodies to penicillins but, fortunately, comparatively few react clinically to penicillin administration. 

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