Evaluation of the Skin Test Reactions in Patients with Delayed Type Rash Induced by Penicillins and Cephalosporins

Aihara, Michiko; Ikezawa, Zenrō

doi:10.1111/j.1346-8138.1987.tb03607.x

Cited by 42 publications

(30 citation statements)

References 8 publications

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“…In the former study, however, the amount (0.1 ml) of reagents used for intradermal testing was larger than that (0.02 ml) used in the latter. Many other studies investigated subjects selected on the basis of positive responses to allergologic tests [21, 23, 29]; therefore, their results are not comparable.…”

Section: Introductionmentioning

confidence: 95%

“…In some cases, challenges with suspect β-lactams have confirmed allergologic test positivity [2, 20, 23, 24, 25, 26, 29]. Many of these studies regarding patients who developed delayed hypersensitivity reactions to β-lactams indicate that these conditions are often associated with late responses to both intradermal (more than 6 h after injection) and patch testing [2, 23, 24, 25, 27, 28]. …”

Section: Introductionmentioning

confidence: 99%

“…Moreover, since 1966 there have been studies suggesting that the delayed reading of intradermal skin tests and/or patch tests can be an effective way of diagnosing nonimmediate allergic reactions to systemically administered β-lactams, such as maculopapular and urticarial rashes [1, 2, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29]. In some cases, challenges with suspect β-lactams have confirmed allergologic test positivity [2, 20, 23, 24, 25, 26, 29].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

Romano

Viola

Mondino

et al. 2002

Int Arch Allergy Immunol

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Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1% of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2%). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients – 93 of whom had experienced maculopapular rashes – displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

Romano

Viola

Mondino

et al. 2002

Int Arch Allergy Immunol

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“…However, there were also patients who react to the provocation test with nonimmediate cutaneous eruptions, particularly maculopapular and urticarial (27,33,42,65). Specifically, in the study by Luque et al (65), which assessed 19 patients with nonimmediate reactions to b-lactams, 12 subjects displaying negative responses to intradermal tests reacted to the challenge.…”

Section: Provocation Testsmentioning

confidence: 99%

“…Generally, intradermal testing appears to be somewhat more sensitive than patch testing (27,28,30,(36)(37)(38)(41)(42)(43). In some studies, subjects with delayed intradermal test positivity and patch test negativity were challenged with positive responses in six of nine patients (30,37,42).…”

Section: Sensitivity and Specificitymentioning

confidence: 99%

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Romano

Blanca

Torres

et al. 2004

Allergy

320

368

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Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during β‐lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug‐specific T‐cell clones obtained from the circulating blood and the skin, suggest that a type‐IV (cell‐mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work‐up, the patient's history is fundamental; patch testing is useful, together with delayed‐reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug.Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to β‐lactams.

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Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

et al. 2021

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IMPORTANCE Cefazolin is the preoperative antibiotic of choice because it is safer and more efficacious than second-line alternatives. Surgical patients labeled as having penicillin allergy are less likely to prophylactically receive cefazolin and more likely to receive clindamycin or vancomycin, which results in higher rates of surgical site infections.OBJECTIVE To examine the incidence of dual allergy to cefazolin and natural penicillins.DATA SOURCES MEDLINE/PubMed, Web of Science, and Embase were searched without language restrictions for relevant articles published from database inception until July 31, 2020.STUDY SELECTION In this systematic review and meta-analysis, a search of MEDLINE/PubMed, Web of Science, and Embase was performed for articles published from database inception to July 31, 2020, for studies that included patients who had index allergies to a natural penicillin and were tested for tolerability to cefazolin or that included patients who had index allergies to cefazolin and were tested for tolerability to a natural penicillin. A total of 3228 studies were identified and 2911 were screened for inclusion.DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 authors. Bayesian meta-analysis was used to estimate the frequency of allergic reactions. MAIN OUTCOMES AND MEASURESDual allergy to cefazolin and a natural penicillin. RESULTSSeventy-seven unique studies met the eligibility criteria, yielding 6147 patients. Cefazolin allergy was identified in 44 participants with a history of penicillin allergy, resulting in a dual allergy meta-analytical frequency of 0.7% (95% credible interval [CrI], 0.1%-1.7%; I 2 = 74.9%). Such frequency was lower for participants with unconfirmed (0.6%; 95% CrI, 0.1%-1.3%; I 2 = 54.3%) than for those with confirmed penicillin allergy (3.0%; 95% CrI, 0.01%-17.0%; I 2 = 88.2%). Thirteen studies exclusively assessed surgical patients (n = 3884), among whom 0.7% (95% CrI, 0%-3.3%; I 2 = 85.5%) had confirmed allergy to cefazolin. Low heterogeneity was observed for studies of patients with unconfirmed penicillin allergy who had been exposed to perioperative cefazolin (0.1%; 95% CrI, 0.1%-0.3%; I 2 = 13.1%). Penicillin allergy was confirmed in 16 participants with a history of cefazolin allergy, resulting in a meta-analytical frequency of 3.7% (95% CrI, 0.03%-13.3%; I 2 = 64.4%). The frequency of penicillin allergy was 4.4% (95% CrI, 0%-23.0%; I 2 = 75%) for the 8 studies that exclusively assessed surgical patients allergic to cefazolin.CONCLUSIONS AND RELEVANCE These findings suggest that most patients with a penicillin allergy history may safely receive cefazolin. The exception is patients with confirmed penicillin allergy in whom additional care is warranted.

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Evaluation of the Skin Test Reactions in Patients with Delayed Type Rash Induced by Penicillins and Cephalosporins

Cited by 42 publications

References 8 publications

Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

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