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Objective: To review antibiotic use and selection for disorders commonly seen in allergy practice., Data Sources: MEDLINE searches were performed cross-referencing antibiotic, antimicrobial, management, and treatment with multiple disorders commonly seen in allergy practice. References of the chosen articles were also examined., Study Selection: Articles were selected based on their relevance to the subject matter., Results: A large body of research is available relevant to both conventional and novel uses of antibiotics. The use of antibiotics is in question for some disorders, whereas novel approaches to therapy with macrolide antibiotics are areas of active investigation. Meanwhile, patterns of microbial resistance continue to evolve., Conclusion: For decades, antibiotics have been traditional first-line treatment for many disorders. Currently, this paradigm appears to be shifting as periods of observation come into favor and nonbacterial causes of inflammation are under greater scrutiny. Nonetheless, appropriate antibiotic selection often remains a key element in the treatment of these disorders. Knowledge of the relevant microbiology is an inherent requirement in selecting antibiotic therapies and necessitates awareness of current trends in bacterial resistance.

Objective: To review antibiotic use and selection for disorders commonly seen in allergy practice., Data Sources: MEDLINE searches were performed cross-referencing the keywords antibiotic, antimicrobial, management, and treatment with multiple disorders commonly seen in allergy practice. References of the chosen articles were also examined., Study Selection: Articles were selected based on their relevance to the subject matter., Results: A large body of research is available that is relevant to both conventional and novel uses of antibiotics. The use of antibiotics is in question for some disorders, whereas novel approaches to therapy with macrolide antibiotics are areas of active investigation. Meanwhile, patterns of microbial resistance continue to evolve., Conclusion: For decades, antibiotics have been traditional first-line treatments for many disorders. Recently, this paradigm appears to be shifting as periods of observation come into favor and nonbacterial causes of inflammation are under greater scrutiny. Nonetheless, appropriate antibiotic selection often remains a key element in the treatment of these disorders. Knowledge of the relevant microbiology is an inherent requirement in selecting antibiotic therapies and necessitates awareness of current trends in bacterial resistance.

Background: The development of pruritus and papules with increased body temperature is a common clinical scenario seen in allergy practice, often leading to a diagnosis of cholinergic urticaria., Objective: To describe an unusual case of miliaria and its significance in the evaluation of patients with pruritic papular eruptions that occur with increased body temperature., Methods: An 18-year-old woman was referred to a local allergist for the evaluation of cholinergic urticaria. For the preceding 6 months, she had experienced a facial burning sensation along with diffuse pruritus accompanied by water-filled pinpoint bumps on her abdomen and extremities during exercise and with hot tub use. The lesions appeared anytime she exercised, and she reduced her workouts because of the associated discomfort. An exercise challenge was performed given the atypical description of her cutaneous symptoms., Results: After indoor aerobic exercise on a treadmill, physical examination revealed facial flushing and numerous pinpoint translucent vesicles covering her abdomen. The diagnosis of miliaria crystallina was made. Given the intense pruritus she experienced with the lesions, she was prescribed cetirizine, 10 mg once daily. However, she noted no improvement with her exercise-induced miliaria. At follow-up 1 year later, her miliaria symptoms had spontaneously resolved with no sequelae observed., Conclusion: Intermittent, pruritic, papular eruptions that occur with perspiration can provide a diagnostic challenge when not present on initial examination. Although this presentation often leads to a diagnosis of cholinergic urticaria, our case illustrates that other disorders must be considered in the differential diagnosis. In these situations, exercise challenge is a valuable adjunct.