Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.

Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.

AimsThe Healing Little Hearts charity provides Cardiac Surgery and Critical Care for children with congenital heart disease in low and middle-income countries. We report the outcomes of the 5th mission to the Hospital Universiti Sains Malaysia.MethodsA prospective, observational study in a Malaysian teaching hospital during a one week charity mission. The visiting charity team collaborated with local adult services to provide assessment, operative intervention and postoperative care to a paediatric cohort.ResultsTwelve operations were undertaken for ten patients (table 1) with a median age of 3.4 years (IQR [2.3–5.8]) and weight 11.9 kg (IQR [9.1–14.5]). For those requiring cardiopulmonary bypass (CPB), median time was 107 min (IQR [92–150]) and cross-clamp (XC) time 73 min (IQR [49.2–98.5]).Abstract G31(P) Table 1 No. Age (Years) Procedure CPB (Mins) XC (Mins) Extubation Time (Hours) 1 2 VSD Closure 60 34 2 2 4.25 REV Procedure (PA-VSD) 320 226 58.08 3 6.91 AVSD Repair 92 72 2.08 4 0.02 TAPVD Repair 95 50 18.33 5 6.33 TOF Repair 150 100 0.75 6 3.08 TOF Repair 154 98 15.58 7 2 Partial PDA Occlusion 0 0 3.75 8 18.67 Redo PV Implantation 111 0 4.5 9 3 VSD Closure, PA de-banding and reconstruction 107 75 1 10 3.75 VSD and PFO Closure 71 47 1.25 Fast-track extubation was performed in 70% with no reintubations. Post-operative morbidity was low and only patient 2 returned to theatre for additional procedures: delayed sternal closure and subsequent re-exploration. Case 3 was complicated by Junctional Ectopic Tachycardia, which resolved with medical management.The team performed the institution’s first redo surgery and neonatal operation. The local cardiac surgeon led his first paediatric VSD closure and Tetralogy of Fallot repair. All patients were extubated and discharged, or eligible for ICU discharge prior to conclusion of the mission.Visiting PICU staff were resident 24 hours a day. The local ICU team were supported by twice daily PICU rounds, multi-disciplinary meetings and bedside teaching for nurses and trainees. The visiting Cardiologist undertook outpatient consultations, intra-and post-operative echocardiography and ECHO teaching. A morning lecture series delivered education to local trainees on topics including cardiac output, inotropes, heart failure and the surgical management of congenital heart disease.ConclusionsHealing Little Hearts provides cardiac surgical and critical care in developing countries. Short, well-planned missions can deliver quality care to a high turnover of patients with safe, early extubation and minimal morbidity, despite limited resources. Future missions will provide ongoing training and support the development of a safe, independent program capable of handling carefully selected paediatric congenital cardiac surgeries.

Purpose“Red eyes” is a common patient complaint. Determining the underlying cause is often difficult as differential diagnoses are numerous. Allergic causes may be easily overlooked as the diagnosis relies on specialized investigation. We wanted to determine the prevalence of relevant allergy in patients with "red eyes", where initial ophthalmological consultation did not result in a definite diagnosis. Methods A multidisciplinary cooperation was established between ophthalmologists, allergologists, dermatologists and pediatricians. The investigation algorithm was based on clinical presentation. Patients with eye symptoms only, or eye and skin symptoms, underwent dermatological investigation comprising patch testing with European baseline series, eye drops and skin prick tests with inhalant allergens and the patients' own ophthalmological products. Patients with eye and airway symptoms were reviewed by allergologists and underwent skin prick tests and specific IgE analysis for relevant allergens and lung function tests. Children were reviewed by pediatric allergologists. Multidisciplinary conferences were held regularly and patients were reviewed and cross‐referred if relevant. Results In total 58 patients (21 males and 37 females) with “red eyes” were included over a one year period. In 21 patients (36%) a relevant allergy was found, diagnosing contact allergy in 15 patients (9 perfume, 3 phenylephrine, 3 others) and IgE‐mediated inhalant allergies in 6 patients. In 37 patients (64%) no allergy was found, and of these 10 patients were diagnosed with rosacea. Conclusion Multidisciplinary cooperation and systematic investigation resulted in identifying relevant allergy in 36% of patients presenting with “red eyes”.