In Vitro Diagnostic Testing for Antibiotic Allergy

Abstract

Allergy to antibiotics is an important worldwide problem, with an estimated prevalence of up to 10% of the population. Reaction patterns for different antibiotics have changed in accordance with consumption trends. Most of the allergic reactions to antibiotics have been reported for betalactams, followed by quinolones and macrolides and, to a lesser extent, to others, such as metronidazole clindamycin and sulfonamides. The diagnostic procedure includes a detailed clinical history, which is not always possible and can be unreliable. This is usually followed by in vivo, skin, and drug provocation tests. These are not recommended for severe, potentially lifethreaten reactions or for drugs that are known to produce a high rate of false positive results. Given the limitations of in vivo tests, in vitro test can be helpful for diagnosis, despite having suboptimal sensitivity. The most highly employed techniques for diagnosing immediate reactions to antibiotics are immunoassays and basophil activation tests, while lymphocyte transformation tests are more commonly used to diagnose non-immediate reactions. In this review, we describe different in vitro techniques employed to diagnose antibiotic allergy.

Drug-induced anaphylaxis: Seven-year single-center survey

“…Serum-specific IgE antibodies (ImmunoCAP ® , Thermo Fisher Scientific) and skin testing were performed at least after a 4 weeks interval after the clinical reaction. For specific IgE a cut-off value of ≥ 0.35 kU/L was considered positive (12). Regarding drugs with standardized skin test concentrations, skin prick tests (SPT) were the first step of the in vivo investigation, and only if negative, intradermal tests (IDT) were carried out.…”

Recent developments and highlights in drug hypersensitivity

“…Different mechanisms can be involved in IRs, IgE‐mediated or off‐target mechanism (Figure ); however, the in vitro tests that are available are only useful for IgE‐mediated reactions, being immunoassays and basophil activation tests (BAT) the most used …”

“…The lymphocyte transformation test, based on the determination of the proliferation under stimulation with the suspected drug, has been used to evaluate NIR [125][126][127] ; however, its sensitivity and specificity are unsatisfactory. 102 To improve these results, new approaches have been focused on the effector response by determining inflammatory mediators, such as IFN-gamma producing cells determination by enzyme-linked immunospot assay (ELISpot), which has shown higher sensitivity and good correlation. 72,[128][129][130][131] Moreover, its combination with STs has demonstrated a potential utility in antibiotic-induced SCARs.…”

The Value of In Vitro Tests to Diminish Drug Challenges

“…This method provides both qualitative and quantitative information and has demonstrated to be highly sensitive, enabling the detection of less than 25 secreting cells per 10 6 peripheral blood mononuclear cells [17,38]. It has been increasingly used for the evaluation of effector cells in NIDHR over the last decades [67,74,77,81,82,83,84].…”