Provocation Tests in Nonimmediate Hypersensitivity Reactions to β-Lactam Antibiotics in Children: Are Extended Challenges Needed?

Rodríguez, Raúl Rodríguez; Lozano, L Moreno; Ortega, A.; Segade, J Borja; Bonilla, Pedro Galindo; Torrijos, Elisa Gómez

doi:10.1016/j.jaip.2018.06.023

Cited by 40 publications

(24 citation statements)

References 19 publications

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“…In studies that performed prolonged DPT, a rate of positive results ranging from 2% to 17.2% was found. Because such rate was >10% in several studies, it has been suggested that prolonged DPT increase the allergy workup sensitivity in nonimmediate reactors to BL.…”

Section: Diagnosismentioning

confidence: 99%

“…Other groups believe that a too short exposure to BL (in terms of days) can be responsible for false‐negative DPT, this being the rationale for performing DPT with a duration of 2‐5 days or even of 7‐10 days to confirm or rule out a delayed hypersensitivity.…”

Section: Diagnosismentioning

confidence: 99%

“…It should be noted that false negative results may also occur because of a too low dosage, missing cofactors like infections, and/or potential tolerance induction by the challenge procedure. 67 In studies that performed prolonged DPT, [69][70][71][75][76][77][78][79][81][82][83]85,86,88,90,95,99,104,105,109,111,112 a rate of positive results ranging from 2% 78 to 17.2% 90 was found. Because such rate was >10% in several studies, 69,70,88,90,95,105,111 it has been suggested that prolonged DPT increase the allergy workup sensitivity in nonimmediate reactors to BL.…”

Section: Drug Provocation Testsmentioning

confidence: 99%

See 2 more Smart Citations

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Romano

Atanasković-Marković

Barbaud

et al. 2020

Allergy

252

373

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A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with betalactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost-effective, as pos-Mono

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Drug Provocation Testsmentioning

confidence: 99%

See 1 more Smart Citation

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Romano

Atanasković-Marković

Barbaud

et al. 2020

Allergy

252

373

View full text Add to dashboard Cite

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“…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%

“…To avoid prolonged DPT, it was also proposed a wash‐out period after the initial DPT in which the patient is under observation at home. If no reaction occurs, DPT is resumed at home with therapeutic doses for several days 50–53 . Regarding NSAIDs, it was suggested to consider their absorption speed to determine steps for DPT 54 …”

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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Reaction Risk to Direct Penicillin Challenges

Blumenthal,

Smith,

Mann

et al. 2024

JAMA Intern Med

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ImportanceWhile direct penicillin challenges might support the expansion of penicillin allergy delabeling efforts, the perceived risk of reactions remains a key barrier.ObjectiveTo evaluate the frequency of reactions to direct penicillin challenges in individuals with penicillin allergy labels and to identify factors associated with such reactions.Data SourcesThree electronic databases were searched (MEDLINE, Web of Science, and Scopus) from inception to July 19, 2023, for primary studies assessing patients undergoing direct penicillin challenges. Articles were included regardless of publication year, language, status, or definition of allergy risk.Study SelectionTwo reviewers independently selected original studies reporting the frequency of immunologically mediated reactions following a direct penicillin challenge in patients reporting a penicillin allergy.Data Extraction and SynthesisTwo reviewers independently extracted data and independently assessed the quality of each primary study using a risk-of-bias tool for prevalence studies.Main Outcomes and MeasuresThe primary outcome was the frequency of reactions to direct penicillin challenges as calculated using random-effects bayesian meta-analysis of proportions. Secondary outcomes included risk factors for reactions and the frequency of severe reactions.ResultsA total of 56 primary studies involving 9225 participants were included. Among participants, 438 experienced reactions to direct penicillin challenges without prior testing, corresponding to an overall meta-analytic frequency of 3.5% (95% credible interval [CrI], 2.5%-4.6%). Meta-regression analyses revealed that studies performed in North America had lower rates of reaction to direct challenges (odds ratio [OR], 0.36; 95% CrI, 0.20-0.61), while studies performed in children (OR, 3.37; 95% CrI, 1.98-5.98), in outpatients (OR, 2.19; 95% CrI, 1.08-4.75), and with a graded (OR, 3.24; 95% CrI, 1.50-7.06) or prolonged (OR, 5.45; 95% CrI, 2.38-13.28) challenge had higher rates of reaction. Only 5 severe reactions (3 anaphylaxis, 1 fever with rash, and 1 acute kidney injury) were reported, none of which were fatal.Conclusions and RelevanceThis systematic review and meta-analysis found that reactions to direct penicillin challenges are infrequent, with rates comparable to indirect challenges after allergy testing. These findings suggest that direct challenges are safe for incorporation into penicillin allergy evaluation efforts across age groups and clinical settings.

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Provocation Tests in Nonimmediate Hypersensitivity Reactions to β-Lactam Antibiotics in Children: Are Extended Challenges Needed?

Cited by 40 publications

References 19 publications

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Advances and novel developments in drug hypersensitivity diagnosis

Reaction Risk to Direct Penicillin Challenges

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