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BackgroundHypersensitivity to beta-lactam antibiotics are usually defined only by the history of suspected previous reaction to these medicines. This definition, however, can erroneously restrict the use of these important therapeutic resources if not assessed by the proper tests. The objective was to assess the presence of hypersensitivity to beta-lactams through adequate testing.MethodsThirty-three patients were referred to our allergic clinic for testing of penicillin hypersensitivity in the period from 2008 to 2011: 22 (66.6%) females and 11 (33.4%) males, with ages ranging from 8 to 88 years. The first 24 (72.7%) patients were tested using only penicillin G, in the form of a prick test followed by an intradermal test with immediate reading, according to the Brazil Ministry of Health protocol (group I). The remaining 9 (27.3%) patients (group II) were subjected to the adaptations of standards-based assessment of hypersensitivity reactions to beta-lactam antibiotics, according to the algorithmic recommendations of the European Network Drug Allergy (ENDA), which includes a prick test and intradermal test with penicillin G, amoxicillin and the suspected beta-lactam, such as clavulanic acid or cephalosporins, with immediate and delayed readings. Patients who had negative skin tests results underwent a provocation test, which is considered the gold standard in determining drug hypersensitivity. In-vitro tests available in Brazil (specific IgE to penicillin and amoxicillin) were performed in patients with a history more suggestive of adverse reactions. It was respected the ENDA recommendation of not subjecting patients with severe reactions to this protocol.ResultsOf the 33 patients, 28 (84.8%) had negative results for the tests. One patient in group I showed inconclusive results. Four patients (12.2%) in group II had positive tests, including 3 for penicillin G and one for amoxicillin.ConclusionsThe results demonstrated that the clinical history collected by medical questionnaires is not the determining factor in confirming a patients’ reaction to penicillin, and shouldn't be the only parameter used to exclude potential future prescriptions. In addition, the results denote that hypersensitivity to other beta-lactam antibiotics should be evaluated in a more proper way for a fuller understanding of each case.

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BackgroundAdverse reactions to local anesthetics (LA) are frequent and often referred to as allergic. Although immune-mediated reactions are rare, it should be investigated for suspected cases. The objective of this study was to determine the frequency of positive skin test to these drugs in patients with a suspected history of allergic reactions and describe the main socio-demographic characteristics of these individuals.MethodsRetrospective study of medical records of patients attended at Policlínica Geral do Rio de Janeiro Allergic Clinic, between 2008 and 2011. The parameters evaluated were the test indication and the patient ages and gender. The drug tested was that the patient had a history of suspicion. Patients underwent skin prick and intradermal tests and subcutaneous provocation. Descriptive statistical analysis of the data was performed.ResultsIt was performed 160 tests (125 female). Three of this total was excluded due to inconclusive results. In women, the highest proportion of tests was in the age group from 41 to 60 years (43%), while in males the higher concentration was at a youngest age group: 21 to 40 years (41%).The most common indication (103 cases, 65%) for the tests was a previous suspected anaphylactic reaction by LA. Seven of 157 tests had a positive result (4.4%), 6 of them occurred in women (4.8%). Only one test resulted in a type of anaphylactic reaction response (0.67%).All patients who presented positive response to the test had a history of per-anesthetic reaction that suggested an immune-mediated mechanism.ConclusionsIn patients with a history of previous reaction to local anesthetics, the skin tests with these drugs have a key role in the prevention of anaphylaxis, and on guidance for adequate anesthetic procedures.