The negative predictive value of 5-day drug provocation test in nonimmediate beta-lactam allergy in children

Celik, Ilknur Kulhas; Güvenir, H.; Hurmuzlu, Selen; Toyran, Müge; Civelek, Ersoy; Kocabaş, Can Naci; Mısırlıoğlu, Emine Dibek

doi:10.1016/j.anai.2019.12.029

Cited by 22 publications

(17 citation statements)

References 26 publications

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“…Of interest is the important role of AX‐CL, coherent with the high pattern of prescription 1,2 . The reported involvement of this formulation in DHR has changed from 12% 8 to over 70% in recent years 15,22,24 . Considered less immunogenic than other BLs, 26 its contribution to both IR and NIR in adults has been reported 27 …”

Section: Discussionmentioning

confidence: 91%

“…This study included a large cohort of children referred to our center for BL allergy evaluation. We followed the classification of IR versus NIR, as initially reported by Terrados et al 10 and used extensively in the literature 8,16,18,20,22‐25 …”

Section: Discussionmentioning

confidence: 99%

“…Patch testing was performed on the patient's back, as described elsewhere 22 . Drugs were mixed in petrolatum 50% w/w at a final concentration of 20 mg.…”

Section: Methodsmentioning

confidence: 99%

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Patterns of response and drugs involved in hypersensitivity reactions to beta‐lactams in children

Torres-Rojas

Pérez-Alzate

Somoza

et al. 2021

Pediatric Allergy Immunology

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Background: Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. Methods: Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and non-immediate reactions. The workup included sIgE, skin testing, and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for non-immediate ones.Results: Of the 510 children included, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%).Among non-immediate reactions (11.4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6-7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities.Conclusions: There were few confirmed cases of either type of reaction. Skin testing proved less valuable in non-immediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have non-immediate reactions, while clavulanic acid selectivity was exclusive to the non-immediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Patterns of response and drugs involved in hypersensitivity reactions to beta‐lactams in children

Torres-Rojas

Pérez-Alzate

Somoza

et al. 2021

Pediatric Allergy Immunology

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“…S1, S2 This point is critical in delayed reactions to βLs, as the diagnostic strength of the allergy work-up is lower than in immediate reactions. 2 Drug-reacting T cells are thought to be the key player in delayed-type hypersensitivity reactions (HRs). Thus, delayed-reading intradermal tests (IDTs), patch tests (PTs), and lymphocyte transformation test (LTT) have been proposed as the only diagnostic tools allowed after severe reactions.…”

Section: Sensitivity and Specificity Of Lymphocyte Transformation Test In Children With Mild Delayed Hypersensitivity Reactions To Betalamentioning

confidence: 99%

Sensitivity and specificity of lymphocyte transformation test in children with mild delayed hypersensitivity reactions to beta‐lactams

Mori

Filì

Sarti

et al. 2020

Allergy

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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%

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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The negative predictive value of 5-day drug provocation test in nonimmediate beta-lactam allergy in children

Cited by 22 publications

References 26 publications

Patterns of response and drugs involved in hypersensitivity reactions to beta‐lactams in children

Patterns of response and drugs involved in hypersensitivity reactions to beta‐lactams in children

Sensitivity and specificity of lymphocyte transformation test in children with mild delayed hypersensitivity reactions to beta‐lactams

Advances and novel developments in drug hypersensitivity diagnosis

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