Penicillin skin testing in the evaluation and management of penicillin allergy

Fox, Stéphanie; Park, Miguel A.

doi:10.1016/j.anai.2010.05.010

Cited by 67 publications

(62 citation statements)

References 38 publications

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“…We have confirmed a high negative predictive value (93.4%) for the ID skin test. Caubet et al [26] reported 91.5% specificity and 66.7% sensitivity for ID skin tests, and Fox and Park [27] also reported a negative predictive value > 95%. DPT is the gold standard to confirm allergy or tolerance to β-lactam antibiotics but this procedure is time consuming and the patient needs to be closely monitored for symptoms in a hospital setting with expert staff [13].…”

Section: Discussionmentioning

confidence: 99%

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Şimşek

Çöğürlü

Aydoğan³

2018

Int Arch Allergy Immunol

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Background: Most children diagnosed with β-lactam allergy based only on history are not truly allergic, and mislabeling leads to use of less effective and more costly alternative broader-spectrum antibiotics, significantly increasing drug resistance. Objective: To determine the frequency and risk factors of confirmed allergy in patients with β-lactam allergy reported by parents or their doctors and evaluate cross-reactivity between β-lactams in children with confirmed allergy. Method: Sixty-seven children with suspected β-lactam allergy were evaluated via history, sIgE measurements, skin tests, and drug provocation tests over a period of 5 years. Results: β-Lactam allergy was confirmed in 10 (14.9%) patients. Six patients had a positive intradermal test result to one or more of the penicillin skin test materials or ceftriaxone, 4 patients with negative skin test results had positive test results with suspected drugs. Age, gender, time interval between evaluation and the initial reaction, personal history of atopy, parental history of drug allergy, reaction type, and multiple drug allergy history were not significantly different between allergic and tolerant patients. For culprit drugs, there was a significant different between the 2 groups; the rate of confirmed diagnosis was significantly higher for cephalosporins such as ceftriaxone, cefuroxime, and cefprozil (p = 0.03). Three patients with allergy to penicillin tolerated cefuroxime; in 4 patients with selective allergy to ceftriaxone tolerated cephalosporins with a dissimilar side chain (cefadroxil, cefuroxime, cefaclor, and cefdinir). Conclusion: Our study indicates that most patients with a suspected β-lactam allergy tolerated this drug. An appropriate diagnostic allergy workup may prevent the use of less effective and more expensive alternatives.

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Section: Discussionmentioning

confidence: 99%

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Şimşek

Çöğürlü

Aydoğan³

2018

Int Arch Allergy Immunol

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“…These phenotypes and endotypes can be further assessed through biomarkers such as skin testing (ST), and specific IgE and basophil activation tests (BAT), which help identify mast cell involvement in the HSRs as well as cross reactivity between drugs [7,9,10,11,25,26,27,28,29]. Levels of basophil/mast cell activation mediators during HSRs, such as tryptase and histamine, or cytokine and leukotriene production, may be helpful in identifying cells involved in the HSR.…”

Section: Drug Hypersensitivity Reactions: New Clinical Approach Thmentioning

confidence: 99%

Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches

Vecillas

Alenazy

Garcia-Neuer

et al. 2017

IJMS

112

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Drug hypersensitivity reactions (HSRs) are increasing in the 21st Century with the ever expanding availability of new therapeutic agents. Patients with cancer, chronic inflammatory diseases, cystic fibrosis, or diabetes can become allergic to their first line therapy after repeated exposures or through cross reactivity with environmental allergens. Avoidance of the offending allergenic drug may impact disease management, quality of life, and life expectancy. Precision medicine provides new tools for the understanding and management of hypersensitivity reactions (HSRs), as well as a personalized treatment approach for IgE (Immunoglobuline E) and non-IgE mediated HSRs with drug desensitization (DS). DS induces a temporary hyporesponsive state by incremental escalation of sub-optimal doses of the offending drug. In vitro models have shown evidence that IgE desensitization is an antigen-specific process which blocks calcium flux, impacts antigen/IgE/FcεRI complex internalization and prevents the acute and late phase reactions as well as mast cell mediator release. Through a “bench to bedside” approach, in vitro desensitization models help elucidate the molecular pathways involved in DS, providing new insights to improved desensitization protocols for all patients. The aim of this review is to summarize up to date information on the drug HSRs, the IgE mediated mechanisms of desensitization, and their clinical applications.

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“…MGH and BWH additionally tested with penicillin G by both epicutaneous and intradermal skin testing. 46 At MGH, the mixing and diluting of penicillin G was performed by the consulting allergist, while BWH used the central pharmacy to compound and deliver the penicillin to the patient’s care unit via pneumatic tube or floor delivery. While the latter method ensured mixing was performed in a standardized fashion, it also caused operational delays since the timing of skin testing was reliant on the inpatient pharmacy workflow.…”

Section: Introductionmentioning

confidence: 99%

Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation

Blumenthal

Shenoy

Wolfson

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

111

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Addressing inaccurate penicillin allergies is encouraged as part of antibiotic stewardship in the inpatient setting. However, implementing interventions targeted at the 10–15% of inpatients reporting a prior penicillin allergy can pose substantial logistic challenges. We implemented a computerized guideline for patients with reported beta-lactam allergy at five hospitals within a single healthcare system in the Boston area. In this paper, we describe our implementation roadmap, including both successes achieved and challenges faced. We explain key implementation steps, including assembling a team, stakeholder engagement, developing or selecting an approach, spreading the change, establishing measures, and measuring impact. The objective is to detail the lessons learned while empowering others to be part of this important, multi-disciplinary work to improve the care of patients with reported beta-lactam allergies.

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Penicillin skin testing in the evaluation and management of penicillin allergy

Cited by 67 publications

References 38 publications

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches

Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation

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