Diagnostic testing for penicillin allergy: A survey of practices and cost perceptions

Sousa‐Pinto, Bernardo; Blumenthal, Kimberly G.; Macy, Eric; Bavbek, Sevim; Benić, Mirjana Stanić; Alves‐Correia, Magna; Dursun, Adile Berna; Jerschow, Elina; Cardoso, Bárbara Kong; Kopač, Peter; Lefevre, S.; Lombardo, Carla; Marraccini, Paolo; Moral, Luis; Norton, Allison E.; Petrișor, Cristina; Poziomkowska-Gęsicka, Iwona; Regateiro, Frederico S.; Santos, Natacha; Saretta, Francesca; Turkalj, Mirjana; Veličković, Jelena; Wöhrl, Stefan; Yazıcıoğlu, Mehtap; Zidarn, Mihaela; Pereira, Mariana; Gomes, Eva; Pereira, Ana Margarida; Delgado, Luís; Fonseca, João

doi:10.1111/all.13951

Cited by 19 publications

(16 citation statements)

References 9 publications

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“…BLs are the most widely used antibiotics and the drugs most frequently involved in IHR [1] in adults and children [40][41][42]. All BL compounds can potentially induce a specific immunological response and, due to their wide prescription, BL allergy is nowadays a worldwide health issue with relevant implications [43][44][45]. One of the main issues is establishing the risk of developing an allergic reaction to cephalosporins prescribed in patients previously diagnosed of penicillin IHR, with different unsolved questions like if this risk can be predicted by ST and/or DPT, or the role of the chemical structure, specifically the side chain, in this recognition [10,[46][47][48][49].…”

Section: Discussionmentioning

confidence: 99%

Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes

Bogas

Mayorga

Martín-Serrano

et al. 2020

Clin Transl Allergy

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Background Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (IHRs), and cefadroxil (CX) the most likely cephalosporin to cross-react with AX, since they share the same R1 side chain, unlike cefuroxime (CO), with a structurally different R1. We aimed to analyse cross-reactivity with CX and CO in patients with confirmed IHRs to AX, including sIgE recognition to AX, CX, CO, and novel synthetic determinants of CX. Methods Fifty-four patients with confirmed IHRs to AX based on skin test (ST) and/or drug provocation test (DPT) were included. Serum sIgE to AX and benzylpenicillin was determined by Radioallergosorbent test (RAST). Two potential determinants of CX, involving intact or modified R1 structure, with open betalactam ring, were synthesised and sIgE evaluated by RAST inhibition assay. Results Tolerance to CX (Group A) was observed in 64.8% cases and cross-reactivity in 35.2% cases (Group B). Cross-reactivity with CO was only found in 1.8% cases from Group B. ST to CX showed a negative predictive value of 94.6%. RAST inhibition assays showed higher recognition to CX as well as to both synthetic determinants (66% of positive cases) in Group B. Conclusions Cross-reactivity with CX in AX allergic patients is 35%, being ST not enough for prediction. R1, although critical for recognition, is not the unique factor. The synthetic determinants of CX, 1-(HOPhG-Ser-Bu) and 2-(pyrazinone) are promising tools for determining in vitro cross-reactivity to CX in AX allergic patients.

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Section: Discussionmentioning

confidence: 99%

Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes

Bogas

Mayorga

Martín-Serrano

et al. 2020

Clin Transl Allergy

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“…Drug mixing time typically requires less than 5 min, but could be longer if batching is performed. A recent survey of North American providers estimated a median time of 20 min to perform the prick and intradermal test respectively [38]. A direct, oral challenge can be performed with a one- or two-step method.…”

Section: Time Cost and Reimbursement Considerations For Pstmentioning

confidence: 99%

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

et al. 2019

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Penicillin allergies are among of the most commonly reported allergies, yet only 10% of these patients are truly allergic. This leads to potential inadvertent negative consequences for patients and makes treatment decisions challenging for clinicians. Thus, allergy assessment and penicillin skin testing (PST) are important management strategies to reconcile and clarify labeled penicillin allergies. While PST is more common in the inpatient setting where the results will immediately impact antibiotic management, this process is becoming of increasing importance in the outpatient setting. PST in the outpatient setting allows clinicians to proactively de-label and educate patients accordingly so beta-lactam antibiotics may be appropriately prescribed when necessary for future infections. While allergists have primarily been responsible for PST in the outpatient setting, there is an increasing role for pharmacist involvement in the process. This review highlights the importance of penicillin allergy assessments, considerations for PST in the outpatient setting, education and advocacy for patients and clinicians, and the pharmacist’s role in outpatient PST.

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“…Since the World Allergy Organization (WAO) International Survey on Diagnostic Procedures and Therapies in Drug Allergy/Hypersensitivity was carried out and published almost a decade ago [ 53 ], there have been several other physician surveys on the diagnosis and management of drug allergy/hypersensitivity to date. By far the area with the highest priority has been on penicillin [ 54 ] and beta-lactam allergy [ 55 ], with surveys led by EAACI's ENDA group and the British Society of Allergy and Clinical Immunology [ 56 ]. There have also been other surveys done specifically by specialists involved in the management of specific DHRs, e.g., aspirin desensitization for coronary artery disease among interventional cardiologists [ 57 ], and SJS/toxic epidermal necrolysis among directors managing Burns Units in the United States [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries

Tang

Fok

Thong

et al. 2020

Asia Pacific Allergy

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Background: The issues and challenges in the diagnosis of drug allergy/hypersensitivity among children and adults in Asia are likely to be different from non-Asian countries. Objective: To study the diagnostic modalities used in the evaluation and management of drug allergy/drug hypersensitivity reactions (DHRs) among member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI). Methods: A questionnaire comprising 41 questions was circulated electronically to member societies and individual members of APAAACI between January 23, 2020 and March 6, 2020. Results: Twenty-six respondents from 15 member societies and 1 individual member responded. European DHR guidelines were most commonly used. Skin prick and intradermal testing was used by 100%, with only 60% having access to commercial penicillin skin test reagents. In vitro-specific IgE tests were used by 75%, and basophil activation test by 56.3% for immediate DHR. Patch tests were used by 75% in contrast to lymphocyte transformation tests by 25% for nonimmediate DHR. Drug provocation tests were used by 68.8%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (93.3%). Human leukocyte antigen (HLA) genotype testing was mandatory among 25% respondents before new carbamazepine prescriptions, and 8.3% for allopurinol prescriptions. Conclusions: There was increased use of skin testing for iodinated contrast media hypersensitivity and patch testing for nonimmediate DHR. HLA genotype testing prior to new carbamazepine, allopurinol and abacavir prescriptions remain variable despite strong associations for severe cutaneous adverse reactions with Asian ethnicity. Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across APAAACI member societies.

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Diagnostic testing for penicillin allergy: A survey of practices and cost perceptions

Abstract: add-on therapy on health-related quality of life and markers of asthma control in severe eosinophilic asthma (MUSCA): a randomised, double-blind, placebo-controlled, parallel-group, multicentre, phase 3b trial.

Cited by 19 publications

References 9 publications

Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes

Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries

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