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Background Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold‐standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other β‐lactams. Methods We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta‐analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses. Results We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%–0.13%; I2 = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non‐immediate index reactions (OR = 0.05; 95% CrI = 0‐0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7–21.5; I2 = 0.3%). Performance of direct DPTs in low‐risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions. Conclusions In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life‐threatening index reactions or patients with positive skin tests—who were mostly not assessed in this analysis ‐, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy.

<b><i>Introduction:</i></b> Malignant biliary obstruction drainage is essential, since jaundice is associated with morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended procedure for biliary drainage, with percutaneous biliary drainage being the classic alternative in cases of unsuccessful ERCP. Recently, endoscopic ultrasound-guided biliary drainage has been emerged as a new option, with EUS-guided choledochoduodenostomy (EUS-CDS) being considered an effective and safe method in the drainage of distal obstructions of the common bile duct. <b><i>Aim:</i></b> The aim of the study was to evaluate the efficacy and safety of EUS-CDS performed in patients with distal malignant biliary obstructions, after failed ERCP. <b><i>Methods:</i></b> Single-center retrospective cohort study between July 2017 and June 2022 including all consecutive patients submitted to EUS-CDS in our center. The primary outcomes were “technical success” and “clinical success,” defined as “resolution of jaundice or improvement in total serum bilirubin level above 50% at 7th day and above 75% at 30th day after the procedure.” Secondary outcomes were procedure-related adverse events, endoscopic reintervention, and survival time. <b><i>Results:</i></b> EUS-CDS was performed in 20 patients (65.0% male; median age 76 years). The most frequent etiology for the biliary obstruction was pancreatic adenocarcinoma (<i>n</i> = 17; 85.0%), and most patients presented at advanced stages of cancer (12/60% in stages III or IV). ERCP failure was mainly due to the presence of obstruction in the duodenal lumen (<i>n</i> = 11; 55.0%). Fully covered metallic stents were used in all patients, mostly HotAxios^TM (<i>n</i> = 15; 75.0%). The technical success rate was 100%, and the clinical success rate was 89.5% (<i>n</i> = 17/19) at 7th day and 93.3% (<i>n</i> = 14/15) at 30th day. Four patients (20.0%) developed cholangitis within the first 30 days after the procedure; there were no late complications, and no patient died as a complication of the procedure. In 2 patients (10.0%), endoscopic reintervention was necessary due to stent migration, incidentally detected. Median survival was 93 days (minimum 5–maximum 751). <b><i>Conclusion:</i></b> EUS-CDS was effective in biliary decompression of malignant obstructions of the common bile duct, with high clinical success and a favorable safety profile.

<b><i>Introduction:</i></b> Eosinophilic gastrointestinal disorders are rare idiopathic conditions characterized by eosinophilic infiltration of any area of the gastrointestinal tract. The clinical presentation is variable and depends on the location and depth of the eosinophilia. Peripheral eosinophilia or elevated serum IgE levels may be present and histological analysis is necessary to a definite diagnosis. <b><i>Presentation:</i></b> A 40-year-old male presented with generalized abdominal pain, nausea, vomiting, diarrhea and anorexia for 1 month and unintended weight loss for 2 months. He had anemia, peripheral eosinophilia, slight hypokalemia, an elevated fecal calprotectin and “a thin sheet of bilateral pleural effusion, reduced-volume ascites and parietal thickening of the entire ileum” in the thoracoabdominal CT scan. An elevated serum IgE was absent and stool for parasites or bacteria, viral serologies, mycobacteria direct exam and culture, and celiac disease screening were negative. The endoscopic exams showed no significant alterations; random ileal biopsies were collected by antegrade motorized spiral enteroscopy and revealed a very fragmented mucosa with inflammatory infiltrate with about 35 eosinophils per high-power field and an altered eosinophil distribution in the ileal wall. The patient initiated oral prednisolone for eosinophilic ileitis, with clinical, analytical, and imagiological improvement. <b><i>Conclusion:</i></b> Eosinophilic ileitis is a rare condition but should be considered in the differential diagnosis of unexplained gastrointestinal symptoms and ascites, particularly in the presence of peripheral eosinophilia. Motorized spiral enteroscopy can be helpful in the diagnosis, allowing the collection of biopsy specimens effectively and safely.