Work up of patients with history of beta-lactam hypersensitivity

Silva, R.; Cruz, L; Botelho, C.; Cadinha, Susana; Castro, Eunice Dias de; Rodrigues, Jorge; Castel-Branco, M.G.

doi:10.1016/j.aller.2009.01.001

Cited by 15 publications

(9 citation statements)

References 16 publications

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“…In total, 27.4% ofthe patients had a positive outcome in our diagnostic evaluation, including the 5.7% having a positive outcome during p.o.7. Two other studies following ENDA guidelines have published similar results (10,11 ). In another large study following intemational guidelines only 8.4% of patients with possible ß-lactam allergy were positive during challenge (12).…”

Section: Discussionmentioning

confidence: 70%

One-week Oral Challenge with Penicillin in Diagnosis of Penicillin Allergy

Hjortlund¹,

Mørtz²,

Skov³

et al. 2012

Acta Derm Venerol

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Many patients experience reactions during penicillin treatment. The diagnosis may be difficult and is mainly based on short-term tests. The European Network for Drug Allergy (ENDA) guidelines proposed for diagnosing penicillin allergy do not include long-term challenge. In this study a total of 405 patients were evaluated. The ENDA guidelines were extended, to include a 7-day oral treatment (p.o.7) with penicillin for all patients who were negative in the ENDA programme. Among the 405 patients; 85 had an immediate reaction to penicillin, and a further 13 reacted during p.o.7. Among the 307 patients with a negative outcome, 88 had a case history of reaction to other β-lactam antibiotics and were subsequently tested with the culprit drug. Thirteen patients had a positive outcome: 3 on single-dose challenge and 10 during p.o.7. The extended penicillin diagnostic work-up was positive in 111 patients, 30.0% showed immediate reactions and 5.7% reacted during p.o.7. Approximately 20% of all patients with positive outcome during penicillin challenge are detected by adding p.o.7 with penicillin to the original ENDA guidelines.

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Section: Discussionmentioning

confidence: 70%

One-week Oral Challenge with Penicillin in Diagnosis of Penicillin Allergy

Hjortlund¹,

Mørtz²,

Skov³

et al. 2012

Acta Derm Venerol

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“…Indeed, this absence caused many problems in managing patients with a history of β-lactam allergy and eventually led many physicians to prescribe more toxic and expensive broad-spectrum antibiotics. During this period, the European Network of Drug Allergy (ENDA) emphasized the importance of these reagents in diagnosing immediate reactions to β-lactams [6,7,8]. Finally, a Spanish company developed new penicillin skin testing reagents with major and minor determinants of penicillin.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Immediate Hypersensitivity to β-Lactam Antibiotics Can Be Made Safely with Current Approaches

Çelik¹,

Aydın²,

Doğu³

et al. 2011

Int Arch Allergy Immunol

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Background: Diagnosing immediate hypersensitivity to β-lactam antibiotics is still a significant problem. Recently, a new penicillin testing reagent was introduced to the market. In this study, the recommendations of the European Network of Drug Allergy (ENDA) for the diagnosis of immediate reactions to β-lactams were followed, and the negative predictive value of this approach with currently available reagents was assessed. Methods: Eighty patients (age range: 6–74 years) with a history of immediate reactions to β-lactams were included. All cases underwent skin testing with benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM), followed by the culprit drug if necessary. If this step was negative, a drug provocation test was offered. If this step also yielded a negative result, then the patients were recommended to use β-lactam antibiotics in future whenever their use was indicated. Results: Overall, 29 patients (36.2%) were diagnosed as β-lactam allergic. The majority of the cases (72.4%) were diagnosed by positive skin tests to either PPL or MDM, whereas 10.3% were diagnosed by skin testing with culprit drugs and 17.2% with drug provocation tests. Regarding the use of the tested drug in the long term, almost half of the contacted patients had had an indication to use the tested drug and the majority had taken the whole course without problems. Conclusions: Although currently available new penicillin tests provide sufficient allergy data, all the steps recommended by ENDA should be followed in the diagnosis of immediate reactions to β-lactams. If these steps are negative, the patients usually tolerate β-lactams and only a few develop mild, non-life-threatening reactions in the long term.

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“…A diagnostic approach using skin tests, IgE dosing and drug challenge is necessary in the diagnosis of β-lactam allergy since none has sufficient sensitivity to be used alone (25). BAT has a similar sensitivity to immunoassays, but the combination of both tests improves sensitivity (20).…”

Section: Figure 2 Box-plot For Si Values (Stimulation Index) For Basmentioning

confidence: 99%

Basophil activation test versus radio-immunoassay in the diagnosis of β-lactam immediate-type hypersensitivity reactions

Petrișor¹,

Gherman-Ionica²,

Bologa³

et al. 2013

Romanian Review of Laboratory Medicine

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Work up of patients with history of beta-lactam hypersensitivity

Abstract: Of the 67 studied cases with history of beta-lactam hypersensitivity reactions, 18 (27%) were confirmed after testing. A combination of skin testing, specific IgE determination and drug challenge is necessary since none has sufficient sensitivity to be used alone.

Cited by 15 publications

References 16 publications

One-week Oral Challenge with Penicillin in Diagnosis of Penicillin Allergy

One-week Oral Challenge with Penicillin in Diagnosis of Penicillin Allergy

Diagnosis of Immediate Hypersensitivity to β-Lactam Antibiotics Can Be Made Safely with Current Approaches

Basophil activation test versus radio-immunoassay in the diagnosis of β-lactam immediate-type hypersensitivity reactions

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