Analysis of profitability in the diagnosis of allergy to beta-lactam antibiotics

Ferré-Ybarz, L.; Argente, Ramón Salinas; Galán, C. Gómez; Selvas, Pilar Duocastella i; Falco, S.

doi:10.1016/j.aller.2014.04.009

Cited by 14 publications

(10 citation statements)

References 14 publications

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“…The identified cost savings with forgoing the skin test was greater in this study than reported in one prior study that identified a reduction by $69 (35% lower) if no skin test was performed. 48 While complete evaluation with skin testing is preferred, especially for patients with higher risk allergy histories, oral challenge only can be considered for patients with mild allergy histories or when there are no personnel trained to perform and interpret skin tests. Indeed, through use of challenge-only evaluations, 818 Canadian children with histories of amoxicillin allergy were safely challenged to amoxicillin without skin testing, and in that study saved their health system $182,393 compared to full skin testing with oral challenge.…”

Section: Discussionmentioning

confidence: 99%

The Cost of Penicillin Allergy Evaluation

Blumenthal

Liu

Banerji

et al. 2018

The Journal of Allergy and Clinical Immunology: In Practice

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Section: Discussionmentioning

confidence: 99%

The Cost of Penicillin Allergy Evaluation

Blumenthal

Liu

Banerji

et al. 2018

The Journal of Allergy and Clinical Immunology: In Practice

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“…Considering that most children (more than 90%) are not confirmed as allergic, this algorithm is heavily resource‐intensive and time‐consuming or could even lead to a number of wrong diagnoses of drug hypersensitivity due to uncertain predictive values of skin tests. In recent years, a number of papers have challenged the academic guidelines and have explored the feasibility of performing OPT without skin tests in children with suspicion of a benign non‐immediate reaction . In spite of reported good results, economic savings, and observed satisfaction by parents and doctors, this attitude is still debated and some authors still consider performing intradermal tests, mainly due to fear of severe reactions during OPT .…”

Section: What To Do With a Child With Suspected Blh In A Specialized mentioning

confidence: 99%

“…In recent years, a number of papers have challenged the academic guidelines and have explored the feasibility of performing OPT without skin tests in children with suspicion of a benign non-immediate reaction. 4,[6][7][8][9] In spite of reported good results, economic savings, and observed satisfaction by parents and doctors, this attitude is still debated and some authors still consider performing intradermal tests, mainly due to fear of severe reactions during OPT. 10 As a result, in current clinical practice, things are not so clear and very different approaches are followed by practicing clinicians.…”

Section: What To Do With a Child With Suspected Blh In A Specializementioning

confidence: 99%

Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

Moral

Caubet

2017

Pediatric Allergy Immunology

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Suspected allergy to penicillins and cephalosporins is very common in childhood. After a proper evaluation, allergy will be confirmed only in a small portion of them. Intradermal tests are usually part of the allergy workup, but they are painful for children and time-consuming, and their role has been debated. A systematic review found only two studies reporting a positive predictive value of skin tests in children of 36% and 33%, respectively, leading to a high rate of inaccurate diagnosis. Moreover, considering that skin tests are negative in more than 90%-95% of cases, an oral provocation test (OPT) is finally needed to confirm tolerance in most of these children. Positive OPT are rare, and even where children demonstrate reproducible signs on challenge, they rarely constitute immediate or serious symptoms. Therefore, OPT to the index antibiotic without skin tests are increasingly being considered an accepted procedure for children with a suspected mild non-immediate reaction related to a beta-lactam antibiotic. Furthermore, a recent research has taken the same approach including children with suspected mild immediate reactions, with similar safety and positive results. In light of recent evidence highlighted, it is now the time for large and multicentric studies to confirm that OPT with the index antibiotic, without skin tests, are safe and convenient for children with a history of a mild reaction with a beta-lactam antibiotic before it can be recommended in pediatric allergy guidelines.

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“…Recently, the Pediatric Task Force of the EAACI Drug Allergy Interest Group suggested the use of DPT without prior skin testing in the cases of non-immediate mild cutaneous reactions [ 45 ]. This approach may also reduce the cost of drug allergy algorithm, up to 35% per patient [ 46 ].…”

Section: Pro: the Tip Of The Icebergmentioning

confidence: 99%

Pro and Contra: Provocation Tests in Drug Hypersensitivity

Soyer

Şahiner

2017

IJMS

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Drug provocation test (DPT) is the controlled administration of a drug to diagnose immune- or non-immune-mediated drug hypersensitivity and the last step for accurate recognition of drug hypersensitivity reactions when the previous diagnostic evaluations are negative or unavailable. A DPT is performed only if other conventional tests fail to yield conclusive results. In each clinical presentation, “to provoke or not to provoke” a patient should be decided after careful assessment of the risk–benefit ratio. Well-defined benefits of DPT include confirmative exclusion of diagnoses of drug hypersensitivity and provision of safe alternatives. However, disadvantages such as safety, difficulty in interpretations of results, lack of objective biomarkers, risks of resensitization, efficiency in daily practice, and lack of standardized protocols, are poorly debated. This review summarizes the current published research concerning DPT, with particular emphasis on the advantages and disadvantages of DPT in an evidence-based manner.

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Analysis of profitability in the diagnosis of allergy to beta-lactam antibiotics

Cited by 14 publications

References 14 publications

The Cost of Penicillin Allergy Evaluation

The Cost of Penicillin Allergy Evaluation

Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

Pro and Contra: Provocation Tests in Drug Hypersensitivity

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