Flucloxacillin Hypersensitivity: Patient Outcomes in a Multicenter Retrospective Study

Kennard, Lucinda; Rutkowski, Krzysztof; Siew, Leonard; Nakonechna, Alla; Sargur, Ravishankar; Egner, William; Shrimpton, Anna; Mirakian, Rita; Wagner, Annette

doi:10.1016/j.jaip.2019.03.018

Cited by 12 publications

(10 citation statements)

References 19 publications

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“…Nevertheless, most studies presented a low risk of bias regarding the other parameters evaluated. A similar frequency of severe reactions following DPTs was found in studies with three or more items classified as “high risk of bias” (0.11%, 95% CrI = 0.01%–0.26%; I 2 = 4.1%), 21,25,26,32,34,37,38,41,46,49,60,96,114,117,119,123,127,128 when compared with the remaining studies (0.06%, 95% CrI = 0.01%–0.14%; I 2 = 59.2%) 22–24,27–31,33,35,36,40,42–45,47,48,50–54,56–58,61–95,97–99,101–113,115,116,120–122,124–126,129–132 …”

Section: Resultssupporting

confidence: 70%

“…Most studies only included outpatients ( n = 69, 66.3%) 28–30,32–34,36,39,40,42–45,47–50 ,52–55,57,59–66,68,72 ,73,75,76,78–81,84–86,90–93,95,97–100 ,103,104,107,108,110,111,115,118 ,120–122,124‐126,128–130,132 From the 96 studies reporting information on the timing of the index reaction, 15 studies (15.6%) only evaluated patients reporting immediate allergic reactions, 24,30,33,38–40,42,54,60 ,67,80,91,102,103,130 and 12 studies (10.7%) exclusively evaluated patients reporting non‐immediate index reactions 50,55,56,76,78,79,86,95,98,100,119,121 …”

Section: Resultsmentioning

confidence: 99%

“…After excluding 2451 records in the screening phase, 351 articles were fully read, of which a total of 112 studies were included in the systematic review 21–50 ,51–100 ,101–132 Of these studies, 108 were included in all general analyses, 21–38 ,40–54 …”

Section: Resultsmentioning

confidence: 99%

“…Prolonged challenges were performed in 41 (39.4%) of the included studies, 22,26,28,29,31,36–38,41,45,47–50 ,55,56,61,65,68,77,78,80,82,86,89,95,98,100 ,101,108,110,115,118–121,124,128–130,132 while graded challenges were performed in 37 (35.6%) studies, 21,23,24,27,33,35,39,42,51,52,54,57–60,62,63,67,69,72,73,75,76,87,88,90,91,94,97,99,103,106,107,116,122,126,127 and 17 (16.3%) studies opted for single dose DPTs 30,34,40,44,53,70,71,79,84,96,104,105,111,112,117,125,131 . Half of the studies ( n = 59, 52.7%) performed a DPT with the suspected culprit drug 25,33,35,36,39,40,47–51,54–57 …”

Section: Resultsmentioning

confidence: 99%

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Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

Cardoso-Fernandes

Blumenthal

Chiriac

et al. 2021

Clinical & Translational All

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Background Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold‐standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other β‐lactams. Methods We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta‐analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses. Results We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%–0.13%; I2 = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non‐immediate index reactions (OR = 0.05; 95% CrI = 0‐0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7–21.5; I2 = 0.3%). Performance of direct DPTs in low‐risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions. Conclusions In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life‐threatening index reactions or patients with positive skin tests—who were mostly not assessed in this analysis ‐, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy.

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Section: Resultssupporting

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

Cardoso-Fernandes

Blumenthal

Chiriac

et al. 2021

Clinical & Translational All

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“…Concerning subjects allergic to penicillins other than aminopenicillins, in a recent study by Kennard et al, 24 4 patients with an immediate hypersensitivity to flucloxacillin and one with a delayed hypersensitivity to it tolerated challenges with amoxicillin and PG, respectively, found negative in allergy tests.…”

Section: Selecting Alternative Penicillinsmentioning

confidence: 99%

β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic

Valluzzi¹,

Colantuono²,

Gaeta³

et al. 2021

JAA

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β-Lactams which include penicillins, cephalosporins, carbapenems, and monobactams are the most common antibiotic classes reported to cause allergic reactions to drugs. This review is mainly about published studies assessing the cross-reactivity among β-lactams in penicillin-or cephalosporin-allergic subjects by carrying out diagnostic tests with alternative β-lactams and, if appropriate, graded challenges. Several studies demonstrated that cross-reactivity connected with the β-lactam ring, causing positive responses to allergy tests with all β-lactams, is infrequent in subjects with an IgE-mediated allergy and anecdotal in those with a T-cell-mediated allergy. Identities or similarities of βlactam side-chain structures are mainly responsible for cross-reactivity among these antibiotics. For example, in aminopenicillin-allergic subjects, cross-reactivity with aminocephalosporins could possibly be over 30%. On the other hand, in a few prospective studies of penicillin-allergic individuals, less than 1% of cases show a cross-reactivity between penicillins and both aztreonam and carbapenems. Particular patterns of allergytest positivity observed in some studies that assessed cross-reactivity among β-lactams seem to indicate that prior exposures may be responsible for coexisting sensitivities. Therefore, pre-treatment skin tests with the related β-lactams are suggested before administering them via graded challenges to β-lactam-allergic patients who need alternative β-lactams.

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Flucloxacillin

2020

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Flucloxacillin Hypersensitivity: Patient Outcomes in a Multicenter Retrospective Study

Cited by 12 publications

References 19 publications

Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis

β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic

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