Determining the negative predictive value of provocation tests with beta‐lactams

Demoly, Pascal; Romano, Antonino; Botelho, C.; Bousquet-Rouanet, L.; Gaeta, Francesco; Silva, R.; Rumi, Gabriele; Cernadas, Josefina; Bousquet, Philippe‐Jean

doi:10.1111/j.1398-9995.2009.02228.x

Cited by 116 publications

(90 citation statements)

References 20 publications

(33 reference statements)

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“…In a multicentre study, patients with a negative provocation test were followed up for 6 months and only 9/118 (7.6%) who took a beta-lactam reacted with a non-immediate reaction. This gave a negative predictive value for beta-lactam oral provocation of 94% [162]. The high predictive value of oral provocation was confirmed in a separate study where new reactions were reported in only 4.5% of patients exposed to penicillin over 90 days [35].…”

Section: Oral Provocation For Immediate Reactionssupporting

confidence: 56%

“…Larger, more recent studies have established that patients with a previous history of penicillin allergy have a low risk of resensitization following assessment by skin testing and an oral course of penicillin [160,161]. Oral provocation testing with beta-lactams has a negative predictive value of 94% [162] with none of the false-negative patients experiencing subsequent life-threatening reactions. This also indicates that oral challenge results in a low conversion rate.…”

Section: Resensitization Following Investigationmentioning

confidence: 99%

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Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

216

220

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Oral Provocation For Immediate Reactionssupporting

confidence: 56%

Section: Resensitization Following Investigationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

216

220

View full text Add to dashboard Cite

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“…The patient has to know whether a reaction can occur after taking a drug, which was tested negatively (14). It is now well known that adverse drug reactions and especially drug allergy/ hypersensitivity are sources of anxiety and lead to an avoidance of the drug (14). On the other hand, the physician has to know whether she or he can safely prescribe a drug with previous negative allergy work-up (14).…”

Section: Diagnosis Of Hypersensitivity To Antibioticsmentioning

confidence: 99%

“…Though not well established, the negative predictive value is important for both the patient and the physician (14). The patient has to know whether a reaction can occur after taking a drug, which was tested negatively (14).…”

Section: Diagnosis Of Hypersensitivity To Antibioticsmentioning

confidence: 99%

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Antibiotic Allergy

Caimmi

Lombardi

et al. 2011

Int J Immunopathol Pharmacol

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Antibiotics are commonly injected during the perioperative period and are responsible of 15% of the anaphylactic reactions. Anaphylaxis triggered by antibiotics primarily involves penicillin and cephalosporin. The management of patients with histories of allergic reactions to antibiotics is a common situation in clinical practice. The confirmation or invalidation of the allergic nature of the reported reaction is not based on in vitro tests, but on a rigorous allergological work-up based on detailed analysis of clinical history, skin tests and drug provocation test. Considering a possible cross-reactivity between penicillins, once an immediate penicillin allergy has been diagnosed, skin testing with the alternative molecule (cephalosporin, carbapenem, aztreonam) is mandatory and, if negative, the relevant drug should be given in an appropriate setting at increasing doses.

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Hypersensitivity Reactions to Drugs

Ott¹

2011

Harper's Textbook of Pediatric Dermatology

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Determining the negative predictive value of provocation tests with beta‐lactams

Cited by 116 publications

References 20 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Antibiotic Allergy

Hypersensitivity Reactions to Drugs

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