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Drug-specific history, skin and in vitro tests can reduce the need for drug provocation tests in betalactam-hypersensitivity
- Source :
- Allergology International, Vol 70, Iss 2, Pp 244-251 (2021)
- Publication Year :
- 2021
- Publisher :
- Elsevier, 2021.
-
Abstract
- Background: Many patients report questionable drug hypersensitivity reactions (DHR) to betalactam antibiotics. A workup is required for objectivation. Direct drug provocation tests (DPTs) omitting a prior allergy workup are increasingly recommended as the primary diagnostic approach. However, apart from the risk of severe side effects, DPTs often are a scarce resource in overloaded healthcare-systems. We investigated how many cases can be solved by drug-specific history, drug-specific IgE, and skin tests obviating the need for DPT. Methods: We conducted a chart review in a retrospective cohort of 932 patients in an allergy outpatient centre from 2016 to 2017. Patients had been submitted to drug-specific history and specific IgE-, skin prick-, intradermal- and patch-tests with early and late readings with a series of penicillins and cephalosporins but DPTs were no option. Results: Overall, positive in vitro and/or skin tests were found in 96/932 (10.3%) patients. Drug-specific IgE was detected in 40/932 (4.3%) patients, 61/787 (7.8%) patients had positive skin tests. In vitro tests to Pencillin V showed the highest rate of positivity 24/479 (5.0%) and early readings of ampicillin the highest amongst the skin tests (3/49, 6.1%). Immediate skin tests were more often positive than delayed ones (75:45). The combination of all parameters including drug-specific history solved 346/932 (37.1%) cases while 586/932 (62.9%) remained unresolved. Self-reported DHR could be less often confirmed in females and young children (p
- Subjects :
- 0301 basic medicine
Male
Allergy
Provocation test
Immunoglobulin E
0302 clinical medicine
Ampicillin
Immunology and Allergy
Child
media_common
biology
General Medicine
Middle Aged
Anti-Bacterial Agents
Specific IgE
Child, Preschool
Female
medicine.drug
Drug
Adult
lcsh:Immunologic diseases. Allergy
medicine.medical_specialty
Adolescent
media_common.quotation_subject
Cephalosporin
Adverse drug reaction
Cross Reactions
beta-Lactams
Drug Hypersensitivity
03 medical and health sciences
Young Adult
Skin test
medicine
Humans
Retrospective Studies
Skin Tests
business.industry
Infant, Newborn
Infant
Retrospective cohort study
medicine.disease
Penicillin
Dermatology
030104 developmental biology
030228 respiratory system
biology.protein
Tryptases
business
lcsh:RC581-607
Subjects
Details
- Language :
- English
- ISSN :
- 13238930
- Volume :
- 70
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Allergology International
- Accession number :
- edsair.doi.dedup.....fa8204302659c9c6ffd632f5f7c1bdae