Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre

Siew, Leonard; Li, Philip H.; Watts, Troy; Thomas, Iason; Ue, Kok Loong; Caballero, M. Rosario; Rutkowski, Krzysztof; Till, Stephen J.; Pillai, Prathap; Haque, Rubaiyat

doi:10.1016/j.jaip.2019.03.015

Cited by 66 publications

(49 citation statements)

References 30 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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“…18 In this large cohort of patients with β-lactam antibiotic allergy in the UK, merely 8% of patients (8 of 99) were sensitized to PPL only and MD only. 18 In countries where the complete panel of penicillin allergenic determinants (PPL, MD, benzylpenicillin, and amoxicillin) were commercially available and routinely incorporated in testing, similar rates of sensitization to PPL only and MD only were also reported; that is, 6% of patients (3 of 48) in Italy and 12% of patients (6 of 51) in Spain. 32,33 The similarity in sensitization rate was attributed to higher use of amoxicillin in European countries.…”

Section: Discussionmentioning

confidence: 84%

Prevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong

Yeung

Lau

et al. 2020

JAMA Netw Open

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IMPORTANCE Allergy to β-lactam antibiotics is one of the most frequently reported drug reactions, but epidemiological data in Chinese populations are lacking. Ethnic-and region-specific sensitization patterns of skin testing for β-lactam antibiotic allergy are also unknown. OBJECTIVE To identify the prevalence, 1-year incidence, and sensitization patterns of β-lactam antibiotic allergy in patients in Hong Kong. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study obtained territorywide, anonymized electronic patient data from the Clinical Management Systems of the Hospital Authority, the sole publicly funded health care system in Hong Kong with facilities in 7 regions (

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“…18 It is particularly relevant regarding assessment of perioperative reactions as DPT is used neither routinely in most centers 46 nor in BLinduced NI-DHRs, for which there is no consensus. 3 The main controversy is DPT duration, and the sensitivity of a several-day protocol with BL compared with a one-day protocol 22,[48][49][50] especially due to the current concern regarding bacterial resistance. The last EAACI position paper considers one-day DPT to be sufficient to confirm diagnosis, 3 although prolonged DPT in NI-DHRs in children seems to be safe and may improve the diagnosis.…”

Section: Drug Provocation Testmentioning

confidence: 99%

“…The main controversy is DPT duration, and the sensitivity of a several‐day protocol with BL compared with a one‐day protocol 22,48–50 especially due to the current concern regarding bacterial resistance. The last EAACI position paper considers one‐day DPT to be sufficient to confirm diagnosis, 3 although prolonged DPT in NI‐DHRs in children seems to be safe and may improve the diagnosis 22 .…”

Section: In Vivo Diagnosismentioning

confidence: 99%

Advances and novel developments in drug hypersensitivity diagnosis

Ariza

Mayorga

Bogas

et al. 2020

Allergy

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The diagnosis of drug hypersensitivity reactions (DHRs) has important implications for both patients and health system. 1 Mainly because an allergy label, whether true or not, implies the avoidance of medications that may be essential, the performance of unnecessary desensitization procedures, or the use of alternative medications. All these alternatives can lead to a less effective treatment, more potential adverse effects, and costs for health systems. 2 Moreover, in the case of antibiotics, it results in bacterial resistance. 3 Considering that there are no specific tests to distinguish between a viral infection and DHRs in the acute phase, a diagnostic work-up should be performed to remove a false label of hypersensitivity. 4 DHRs diagnosis is complex, time consuming, needs to be done by trained staff, and it is not standardized for many drugs. It is mainly based on skin testing (ST) and drug provocation tests (DPTs),

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Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre

Cited by 66 publications

References 30 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

Prevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong

Advances and novel developments in drug hypersensitivity diagnosis

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