Comparing Direct Challenge to Penicillin Skin Testing for the Outpatient Evaluation of Penicillin Allergy: A Randomized Controlled Trial

Mustafa, S Shahzad; Conn, Kelly M.; Ramsey, Allison

doi:10.1016/j.jaip.2019.05.037

Cited by 98 publications

(68 citation statements)

References 27 publications

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“…After excluding 2451 records in the screening phase, 351 articles were fully read, of which a total of 112 studies were included in the systematic review 21–50 ,51–100 ,101–132 Of these studies, 108 were included in all general analyses, 21–38 ,40–54 …”

Section: Resultsmentioning

confidence: 99%

Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

Cardoso-Fernandes

Blumenthal

Chiriac

et al. 2021

Clinical & Translational All

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Background Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold‐standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other β‐lactams. Methods We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta‐analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses. Results We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%–0.13%; I2 = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non‐immediate index reactions (OR = 0.05; 95% CrI = 0‐0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7–21.5; I2 = 0.3%). Performance of direct DPTs in low‐risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions. Conclusions In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life‐threatening index reactions or patients with positive skin tests—who were mostly not assessed in this analysis ‐, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy.

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Section: Resultsmentioning

confidence: 99%

Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

Cardoso-Fernandes

Blumenthal

Chiriac

et al. 2021

Clinical & Translational All

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“…If the patient gives only a low-risk history of IgE-mediated penicillin allergy that includes symptoms such gastrointestinal intolerance, headache, fatigue, or nonspecific pruritus, or gives a family history only, an oral challenge can be administered to document the absence of allergy ( Box 2 ). If the reaction occurred in the distant past (>10 years), the likelihood is reduced even further ( 653 , 658 , 663 , 682 , 683 , 685 , 686 ). The risk for severe amoxicillin-mediated anaphylaxis has decreased over time and is rare.…”

Section: Management Of Persons Who Have a History Of Penicillin Allergymentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,720

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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“…The “high risk” patient group generally includes recent reactions (< 1 year ago), patients with comorbidities, pregnant women, systemic involvement (encompassing all SCARs) and immediate reactions with angioedema or anaphylaxis. As highlighted in the previously reported studies, the evaluation of direct OPT was performed excluding high-risk patients ( Mill et al, 2016 ; Vezir et al, 2016 ; Iammatteo et al, 2019 ; Kuruvilla et al, 2019 ; Mustafa et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, also in the US, Mustafa et al investigated children and adults with history of penicillin allergy and developed a randomized trial comparing two strategies: ST plus OPT versus direct OPT to amoxicillin in low-risk patients ( Mustafa et al, 2019 ). Of the total, 13 children (<5 years) were submitted to direct OPTs (all were negative) and 159 patients (≥5 years old) with mild cutaneous reactions underwent ST or direct OPT.…”

Section: How Can We Improve the Diagnosis Of Penicillin Allergy?mentioning

confidence: 99%

Direct Oral Provocation Test Is Safe and Effective in Diagnosing Beta-Lactam Allergy in Low-Risk Children With Mild Cutaneous Reactions

Felix

Kuschnir

2020

Front. Pharmacol.

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Comparing Direct Challenge to Penicillin Skin Testing for the Outpatient Evaluation of Penicillin Allergy: A Randomized Controlled Trial

Cited by 98 publications

References 27 publications

Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

Sexually Transmitted Infections Treatment Guidelines, 2021

Direct Oral Provocation Test Is Safe and Effective in Diagnosing Beta-Lactam Allergy in Low-Risk Children With Mild Cutaneous Reactions

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