Controversies in drug allergy: Testing for delayed reactions

Phillips, Elizabeth; Bigliardi, Paul L.; Bircher, Andreas J.; Broyles, Ana Dioun; Chang, Yoon-Seok; Chung, Wen‐Hung; Lehloenya, Rannakoe; Mockenhaupt, Maja; Peter, Jonny; Pirmohamed, Munir; Roujeau, J C; Shear, Neil H.; Tanno, Luciana Kase; Trubiano, Jason A; Valluzzi, Rocco Luigi; Barbaud, A.

doi:10.1016/j.jaci.2018.10.030

Cited by 153 publications

(174 citation statements)

References 43 publications

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“…86 In the case of NIR, due to the potential risk of triggering a severe reaction, the diagnostic procedure starts with a patch test and if negative, IDTs, although recent studies suggest the performance of IDTs with no need of a previous patch testing. 87,88 Unfortunately, the real diagnostic value of STs for SCARs is unknown, as confirmatory DPTs cannot be performed for ethical reasons due to the risk of inducing a severe reaction when reintroducing the culprit drug. 55 The value for new drugs as biologicals has been analysed and positive delayed-reading IDTs confirmed NIR to bortezomib.…”

Section: In Vivo Testsmentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: In Vivo Testsmentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…Moreover, PT is cheaper, faster and easier to perform in routine practice in comparison to IDRs. However, as recently published, a collaboration of large international networks is needed to develop and standardize in vivo diagnostic approaches …”

Section: Discussionmentioning

confidence: 99%

“…However, as recently published, a collaboration of large international networks is needed to develop and standardize in vivo diagnostic approaches. 12,25 A limitation of our study is its retrospective design, but clinical data at the acute phase were correctly collected because all patients received care on our department. Allergologic explorations were always performed with the same protocol by two practitioners who collected data in a standardized form.…”

Section: Discussionmentioning

confidence: 99%

“…Cross‐reactivity among BL is usually explored by skin tests, sometimes followed by rechallenges . However, lack of consensus and standardization remains on how to explore different types of non‐immediate CADRs . Patch tests (PTs) have been long recommended to explore non‐immediate CADRs .…”

Section: Introductionmentioning

confidence: 99%

“…24 However, lack of consensus and standardization remains on how to explore different types of non-immediate CADRs. 25 Patch tests (PTs) have been long recommended to explore non-immediate CADRs. 26 They are followed, since more recently, by delayed readings of prick and IDRs (P-IDRs) in case of negative results and only for nonsevere cases, but their added value in non-immediate CADRs induced by BL remains under-reported.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Bérot¹,

Géner²,

Ingen‐Housz‐Oro

et al. 2019

Acad Dermatol Venereol

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Background Cross‐reactivity among beta‐lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives To evaluate cross‐reactivity beyond BLs in patients with non‐immediate cutaneous adverse drug reaction (non‐immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods We conducted a retrospective single‐centre study in consecutive patients consulting between 2010 and 2018 with an active BL‐suspected non‐immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P‐IDR)] for at least three penicillin's subclasses and amino‐ and non‐amino‐cephalosporins (at least one aminocephalosporin). Cross‐reactivity among subclasses was investigated for patients with positive tests. Results We included 56 patients, among whom 46 amoxicillin‐suspected were and seven cephalosporin‐suspected. Twenty‐nine had severe CADR, and 27 had non‐immediate maculopapular exanthema (MPE). Twenty‐two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin‐suspected, 10 (55.6%) showed cross‐reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non‐aminocephalosporin. No amoxicillin‐ or cephalosporin‐suspected patient showed cross‐reactivity with aztreonam or carbapenems. P‐IDR showed cross‐reactivity only once. Conclusion After a suspected BL‐induced non‐immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross‐reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross‐reactivity was frequent and PT was sufficient to this purpose. The frequent cross‐reactivity among penicillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross‐allergies are rarer.

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Development and Validation of a Penicillin Allergy Clinical Decision Rule

et al. 2020

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IMPORTANCE Penicillin allergy is a significant public health issue for patients, antimicrobial stewardship programs, and health services. Validated clinical decision rules are urgently needed to identify low-risk penicillin allergies that potentially do not require penicillin skin testing by a specialist. OBJECTIVE To develop and validate a penicillin allergy clinical decision rule that enables point-of-care risk assessment of patient-reported penicillin allergies. DESIGN, SETTING, AND PARTICIPANTSIn this diagnostic study, a multicenter prospective antibiotic allergy-tested cohort of 622 patients from 2 tertiary care sites in Melbourne, Australia (Austin Health and Peter MacCallum Cancer Centre) was used for derivation and internal validation of a penicillin allergy decision rule. Backward stepwise logistic regression was used to derive the model, including clinical variables predictive of a positive penicillin allergy test result. Internal validation of the final model used bootstrapped samples and the model scoring derived from the coefficients. External validation was performed in retrospective penicillin allergy-tested cohorts consisting of 945 patients from Sydney and Perth, Australia, and Nashville, Tennessee. Patients who reported a penicillin allergy underwent penicillin allergy testing using skin prick, intradermal, or patch testing and/or oral challenge (direct or after skin testing).

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Controversies in drug allergy: Testing for delayed reactions

Cited by 153 publications

References 43 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Development and Validation of a Penicillin Allergy Clinical Decision Rule

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