Non‐immediate‐reading skin tests and prolonged challenges in non‐immediate hypersensitivity to beta‐lactams in children

Lezmi, Guillaume; Alrowaishdi, Fuad; Bados-Albiero, A.; Scheinmann, P.; Blic, J. de; Ponvert, C.

doi:10.1111/pai.12826

Cited by 41 publications

(55 citation statements)

References 36 publications

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“…On the other hand, in recent years, it has been suggested not to perform ST in children, in mild‐to‐moderately severe delayed reactions, but to simply prescribe a DPT . Several protocols have been proposed for DPT in children reporting delayed reactions, over a 2‐ to 5‐day period . These protocols refer to children reporting a history of mild reactions, and the authors suggest that increasing the duration of DPT may improve its diagnostic performance without increasing the risk of severe reactions during the observation period or at home.…”

Section: Resultsmentioning

confidence: 99%

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Diaferio

Chiriac

Leoni

et al. 2019

Pediatric Allergy Immunology

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Background There is no perfect agreement on how to perform an allergy workup in suspected beta‐lactam (BL)–allergic children, since skin test (ST)–induced pain is often a limitation. The aim of the study was to assess the possibility of reducing the number of ST in children when performing a complete allergy workup for BL hypersensitivity reactions. Methods A retrospective analysis of all patients referring to the Allergy Unit of the University Hospital of Montpellier (France) with positive responses in immediateand non–immediate‐reading ST to a BL over a 16‐year period was performed, to determine the positive predictive value (PPV) of ST. All pediatric patients with a suspected BL hypersensitivity were skin‐tested with the suspected drug only, during the following 54 months. Results A total of 319 patients reporting 328 BL reactions were included in the retrospective study. The PPV of ST for the reported drug was of 99.4%. Based on the results, the number of patients to include in the prospective study was estimated to be 101. In the prospective study, 229 children were included. We diagnosed a BL hypersensitivity in 12 children (5.2%): Diagnosis was reached in 6 (50.0%) through ST (delayed reading for all) and in 6 through drug provocation test (DPT). Conclusion ST with BL should therefore be performed as a screening test, before DPT, and testing only the suspected drug may be sufficient when dealing with children.

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Section: Resultsmentioning

confidence: 99%

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Diaferio

Chiriac

Leoni

et al. 2019

Pediatric Allergy Immunology

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“…In pediatric populations, immediate reactions during DPTs performed to explore nonimmediate reactions have been reported in some, but not all studies. 2,8 All such reactions were mild, most resolved spontaneously or with H1-antihistamines, and none occurred after a first low dose of antibiotic. 2,8 We thus started DPTs during consultation, rather than in a DCU, and a first therapeutic dose was given instead of gradually increased doses.…”

Section: Safety and Cost Effectiveness Of Supervised Ambulatory Drug mentioning

confidence: 99%

“…2,8 All such reactions were mild, most resolved spontaneously or with H1-antihistamines, and none occurred after a first low dose of antibiotic. 2,8 We thus started DPTs during consultation, rather than in a DCU, and a first therapeutic dose was given instead of gradually increased doses. As expected, we did not observe any immediate reaction after intake of the first dose.…”

Section: Safety and Cost Effectiveness Of Supervised Ambulatory Drug mentioning

confidence: 99%

“…1 These reactions often include urticaria, maculopapular rashes (MPR), and/or edema. 2 Drug provocation testing (DPT) is the reference standard for confirming the diagnosis of DHR. A direct DPT, without prior skin or in vitro testing, has been proposed to explore nonimmediate nonsevere reactions in children, 3 and is safe.…”

Section: Safety and Cost Effectiveness Of Supervised Ambulatory Drug mentioning

confidence: 99%

“…2,8 All such reactions were mild, most resolved spontaneously or with H1-antihistamines, and none occurred after a first low dose of antibiotic. In pediatric populations, immediate reactions during DPTs performed to explore nonimmediate reactions have been reported in some, but not all studies.…”

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confidence: 99%

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Safety and cost effectiveness of supervised ambulatory drug provocation tests in children with mild non‐immediate reactions to beta‐lactams

Jaoui

Delalande

Siouti

et al. 2019

Allergy

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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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Non‐immediate‐reading skin tests and prolonged challenges in non‐immediate hypersensitivity to beta‐lactams in children

Abstract: Background: A minority of children reporting non-immediate reactions to beta-lactams

Cited by 41 publications

References 36 publications

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Safety and cost effectiveness of supervised ambulatory drug provocation tests in children with mild non‐immediate reactions to beta‐lactams

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

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