Relevance of the determination of serum‐specific IgE antibodies in the diagnosis of immediate <i>β</i>‐lactam allergy

Fontaine, Christophe; Mayorga, Cristobalina; Bousquet, Philippe‐Jean; Arnoux, B.; Torres, Marı́a José; Blanca, Miguel; Demoly, Pascal

doi:10.1111/j.1398-9995.2006.01268.x

Cited by 183 publications

(141 citation statements)

References 12 publications

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“…The sensitivity of ImmunoCAP was found to be higher in cases where the patient's allergic reaction was anaphylaxis, while the sensitivity of a non-commercial RAST assay was highest in patients who had anaphylactic shock with hypotension [165]. Positive and negative predictive values were estimated at 45% and 77.1% with ImmunoCap and 18.5% and 81.5% with RAST.…”

Section: Laboratory Investigationsmentioning

confidence: 95%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Laboratory Investigationsmentioning

confidence: 95%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

229

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“…Specific IgE can be measured for limited number of drugs including penicillins, insulin, muscle relaxants and quinolones. Although its sensitivity is low, recent studies have reported that it is positive in patients with a history of anaphylaxis (31). Since not only the drug itself but also its metabolites can be allergen, the value of measuring specific IgE is low.…”

Section: In Vitro Diagnostic Testsmentioning

confidence: 99%

“…Since not only the drug itself but also its metabolites can be allergen, the value of measuring specific IgE is low. Sensitivity for penicilloylIgE which is measured for the major determinant of penicilin (PPL) was reported to be 65-85% compared to skin test and 32-50% compared to the combination of skin test and drug stimulation test (31,32). Minor determinant penicilin IgE antibodies are not measured.…”

Section: In Vitro Diagnostic Testsmentioning

confidence: 99%

Çocuklarda ilaç alerjileri

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2012

Tpa

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Review Sum maryDrug allergy when compared with other allergic diseases can be the cause of very serious reactions and can be life-threatening if neglected. In clinical practice, a wide range of symptoms from mild urticaria to anaphylaxis can be observed so that it can mimic the symptoms of all other allergic diseases. One of the significant consequences of allergic drug reactions is the use of less effective, more expensive or more toxic drugs in the future. A thorough history is essential to the management of drug allergy. Laboratory testing has a very limited role in the management of drug allergy. Confirmatory tests, if avaliable, should be used to determine the allergic status of the patient. If these tests are not avaliable, depending on the type of clinical reaction previously demonstrated, a graded challenge or desensitization may be considered. Education of the patient and primary care physician is an important component of management. (Turk Arch Ped 2012; 47: 86-91)

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“…Hence, false negative results may occur, as is well recognised with penicillin. 8 False positive specific IgE results are also recognised. 9 Therefore, NICE recommends that specific IgE testing is not used to diagnose drug allergy in a non-specialist setting.…”

Section: What Can We Do In the Drug Allergy Clinic?mentioning

confidence: 99%

Introduction to drug allergy, and whom to refer for specialist assessment?

Kasternow

Karim

2016

Clinical Medicine

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Drug allergy is defined as an adverse drug reaction with an established immunological mechanism. The National Institute for Health and Care Excellence published clinical guidelines on drug allergy in 2014 and quality standards in 2015. The intention of this article is to highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical of course for patient safety, but also for better use of the drugs that we have available and to reduce unnecessary avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. It is, therefore, important to highlight to general physicians and physicians of other specialties, those patients who do require referral for specialist review. IntroductionAn adverse drug reaction (ADR) is defined as 'an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product '.1 However, drug allergy has a more specific definition. It has been defined by the British Society for Allergy and Clinical Immunology (BSACI) as 'an ADR with an established immunological mechanism'.2,3 The subject of drug allergy is very topical, particularly with the focus on patient safety, and has attracted the attention of the National Institute for Health and Care Excellence (NICE) with publication of clinical guidelines on drug allergy in 2014 and quality standards in 2015.3,4 The intention of this article is not to provide a comprehensive review of drug allergy, but rather to introduce the topic and highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical for patient safety, for better use of the drugs that we have available and to reduce the unnecessary ABSTRACT Introduction to drug allergy, and whom to refer for specialist assessment?avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. AssessmentThere is an issue of perception versus reality with respect to drug allergy. The prevalence of drug allergy estimated by patients in the general population is much higher than can be found objectively. For example, there are significant differences in the perception of the frequency of penicillin allergy. 5 This raises an important point in the initial evaluation of the patient with suspected drug allergy. In most cases, clinical ...

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Relevance of the determination of serum‐specific IgE antibodies in the diagnosis of immediate β‐lactam allergy

Cited by 183 publications

References 12 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Çocuklarda ilaç alerjileri

Introduction to drug allergy, and whom to refer for specialist assessment?

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