Oral challenges are needed in the diagnosis of β‐lactam hypersensitivity

Bousquet, Philippe‐Jean; Pipet, A.; Bousquet-Rouanet, L.; Demoly, Pascal

doi:10.1111/j.1365-2222.2007.02867.x

Cited by 117 publications

(90 citation statements)

References 27 publications

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“…Indications for skin tests are reported in Boxes 2 and 3. When positive, skin tests reduce the requirement for drug challenge [102,103]. Testing should be carried out shortly after the reaction has occurred because a long interval between the reaction and skin testing reduces the likelihood of a positive response [104].…”

Section: Skin Testingmentioning

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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Section: Skin Testingmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

View full text Add to dashboard Cite

show abstract

“…In comparison, a study conducted by Bousquet PJ et al, which also followed the ENDA recommendations to test allergic reactions to β lactams, also included adults with a median age of 32 years. 19 A meta-analysis conducted by Harandian et al, has concluded that the prevalence of allergy to penicillin groups is more in adults (7.78%) when compared to children (1.98%). 22 It was also observed that all patients who were allergic to β lactam antibiotics were less than 56 years of age.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have utilized the skin prick test in different dilutions in order to identify immediate reactions to β lactam antibiotics. 19,25 A study by Sullivan et al has utilized skin tests in the detection of penicillin allergy only, wherein a total of 63% of patients tested positive and out of these, 57.2% were inpatients. 21 Another study by K. Lammintausta et al, assesses the usefulness of skin tests to prove drug hypersensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, amongst positive drug provocation, 52 (65.8%) involved a penicillin and 27 (34.2%) a cephalosporin. 19 According to this study, among patients who presented with itching as one of the reactions following drug provocation test, the class of drug involved in order was, piperacillin + tazobactam (3), amoxicillin + clavulanic acid (2) and ceftriaxone (1) with both dermatological and systemic manifestations as shown in Table 3. In a similar study by Ratzon et al, 23 (88%) of the patients showed skin manifestations following a short drug provocation test.…”

Section: Discussionmentioning

confidence: 99%

“…19 In the present study, expecting a similar result by skin tests, sample size was estimated considering a relative precision of 15% and desired confidence level of 95% which worked out to be 76 subjects.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of immediate reactions to β lactam antibiotics using a comprehensive diagnostic protocol

Bhagwat

Anuradha

2017

Int J Basic Clin Pharmacol

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Background: β lactam antibiotics are commonly prescribed groups of antibacterial drugs for various infections however the prevalence of its allergic effects is not clear in our country, hence the need for an effective diagnostic protocol to determine immediate hypersensitivity reactions. The objective was to formulate a diagnostic protocol for evaluating immediate drug hypersensitivity to β lactam antibiotics.Methods: A prospective study was conducted at a tertiary care hospital. Adults who were prescribed any class of β lactam antibiotic were included. Non irritating concentrations of the antibiotic as per The European Network on drug Allergy were used. A strict three step diagnostic algorithm with skin prick test followed by intradermal test and drug provocation test, with 20 minutes observation period between each step, to determine cutaneous allergic reactions was followed.Results: The most commonly prescribed drug was cefazolin, followed by ceftriaxone, and cefoperazone + sulbactam combination. The culprit drugs were ceftriaxone in 4 (4.7%) patients, followed by piperacillin + tazobactam combination in 3 (3.5%), amoxicillin + clavulanic acid in 2 (2.3%) and 1 (1.1%) each for cefotaxime and cefepime + tazobactam combination. No patients were positive for skin prick test; 2.4% were positive for intradermal test and 10.6% were positive for drug provocation test.Conclusions: This diagnostic protocol is apt to adequately diagnose immediate reactions to β lactam antibiotics and henceforth can be used effectively in India. However, the skin prick test may be excluded but the intradermal test and drug provocation test is crucial to identify these immediate reactions.

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Prevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong

Yeung

Lau

et al. 2020

JAMA Netw Open

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IMPORTANCE Allergy to β-lactam antibiotics is one of the most frequently reported drug reactions, but epidemiological data in Chinese populations are lacking. Ethnic-and region-specific sensitization patterns of skin testing for β-lactam antibiotic allergy are also unknown. OBJECTIVE To identify the prevalence, 1-year incidence, and sensitization patterns of β-lactam antibiotic allergy in patients in Hong Kong. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study obtained territorywide, anonymized electronic patient data from the Clinical Management Systems of the Hospital Authority, the sole publicly funded health care system in Hong Kong with facilities in 7 regions (

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Oral challenges are needed in the diagnosis of β‐lactam hypersensitivity

Abstract: In the diagnosis of beta-lactams allergy, if all skin tests are negative, skin tests with other determinants and provocation tests under strict surveillance are mandatory.

Cited by 117 publications

References 27 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Evaluation of immediate reactions to β lactam antibiotics using a comprehensive diagnostic protocol

Prevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong

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