Diagnosis of penicillin allergy revisited: the value of case history, skin testing, specific IgE and prolonged challenge

Hjortlund, Janni; Mørtz, Charlotte G.; Skov, Per Stahl; Bindslev‐Jensen, Carsten

doi:10.1111/all.12195

Cited by 94 publications

(114 citation statements)

References 34 publications

(50 reference statements)

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“…This finding is consistent with the study of Hjortlund et al [32] who reported that 6 patients categorized as NIR based on histories, reacted immediately during challenge testing. Hence, the case history is not generally sufficient to discriminate between IRs and NIRs [33].…”

Section: Discussionsupporting

confidence: 92%

Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests

et al. 2015

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Section: Discussionsupporting

confidence: 92%

Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests

et al. 2015

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“…Although a 7-day challenge has been shown to yield more positive reactions than shorter challenges [150], in the UK, it is common practice to undertake a 3-to 5-day drug challenge.…”

Section: Skin Tests For Non-immediate Hypersensitivity Reactionsmentioning

confidence: 99%

“…Table S2. Examples of increasing drug doses during provocation, modified from Messaad and colleagues [150]. Table S3.…”

Section: Supporting Informationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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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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“…First, drug allergies differ from respiratory and food allergies in terms of the physiological changes that are induced. For instance, it has been shown that penicillin allergies, which are often delayed reactions, involve an immunoglobulin E-independent mechanism, 17 while respiratory allergies such as asthma occur instantaneously as a result of immunoglobulin Emediated hypersensitivity. 15,33 Second, respiratory and food allergies are typically manifested during routine daily activities, while a drug allergy is less apparent, and 9 /L) of eosinophil counts, the discriminative power was 60% sensitivity and 58% specificity for glioma cases compared with nontumor controls.…”

Section: Discussionmentioning

confidence: 99%

“…The results showed that positive PenSTs were observed at similar frequencies among the 4 subsets of control subjects, and collectively, the incidence of positive results (12.5%) was comparable to what has been observed in the general population (7.3%-10.2%). 17,23 All of these results indicated that the control subjects might be able to represent normal subjects. Although no significant differences were observed in eosinophil counts and PenST results between glioma patients with or without steroid use, steroids may have confounded the results.…”

mentioning

confidence: 86%

Increased rate of positive penicillin skin tests among patients with glioma: insights into the association between allergies and glioma risk

Han

Huang²,

Wang³

et al. 2014

JNS

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Object. Allergy and immunoglobulin E levels are inversely associated with glioma risk. Previous studies have focused on respiratory and food allergies, and little information is available regarding drug allergies. This study evaluated the rate of positive penicillin skin tests (PenSTs) and blood eosinophil counts in a large population of patients with glioma compared with nontumor controls to provide evidence for the relationship between drug allergies and glioma risk.Methods. A retrospective case-control study was conducted in patients diagnosed with glioma (n = 913) between January 2004 and June 2013. The study patients were matched with nontumor controls (n = 1091) for age, sex, and date of admission to the hospital. Preoperative results of the PenST and eosinophil counts were obtained, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using conditional logistic regression models, while a Kaplan-Meier analysis was used to assess overall survival.Results. The percentage of positive PenSTs was higher among patients with glioma than in control subjects. The age-, sex-, and admission date-adjusted OR for positive versus negative PenSTs was 2.392 (95% CI 1.891-3.026). Eosinophil counts were also higher in glioma cases than in controls: the OR for eosinophil > 0.06 × 10 9 /L versus ≤ 0.06 × 10 9 /L was 1.923 (95% CI 1.608-2.301). There was no association between positive PenST/eosinophil counts and glioma grade or patient survival (n = 105).Conclusions. In contrast to previously reported relationships between allergy and glioma, in the present study a significantly higher rate of positive PenSTs and higher eosinophil counts were found in patients with glioma than in nontumor controls. These results suggest a complex relationship between allergies and glioma development. (http://thejns.org/doi/abs/10.3171/2014 KeY WorDS • glioma • penicillin • allergy • eosinophil • skin test • case control • oncologyAbbreviations used in this paper: AVM = arteriovenous malformation; CI = confidence interval; OR = odds ratio; PenST = penicillin skin test.

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Diagnosis of penicillin allergy revisited: the value of case history, skin testing, specific IgE and prolonged challenge

Cited by 94 publications

References 34 publications

Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests

Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests

Management of allergy to penicillins and other beta‐lactams

Increased rate of positive penicillin skin tests among patients with glioma: insights into the association between allergies and glioma risk

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