Prospective assessment of diagnostic tests for pediatric penicillin allergy

Ibáñez, María Dolores; Río, Pablo Rodríguez del; Lasa, E.; Joral, Alejandro; Ruíz-Hornillos, Javier; Muñoz, Candelaria; Gómez‐Traseira, Carmen; Escudero, Carmelo; Rivera, José M.; Garriga‐Baraut, Teresa; González-de-Olano, David; Rosado, Ana; Sánchez‐García, Silvia; Bustamante, Socorro Pérez; Vilchez, M A Padial; Montaño, P. Prieto; Morillo, Rocio Candon; Iglesia, Eva Macías; Vila, Angélica Feliú; Valbuena, Teresa; Lopez-Patiño, Ana; Martorell, A.; Sastre, Joaquı́n; Audícana, M.

doi:10.1016/j.anai.2018.05.013

Cited by 77 publications

(105 citation statements)

References 30 publications

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“…In studies that performed prolonged DPT, a rate of positive results ranging from 2% to 17.2% was found. Because such rate was >10% in several studies, it has been suggested that prolonged DPT increase the allergy workup sensitivity in nonimmediate reactors to BL.…”

Section: Diagnosismentioning

confidence: 99%

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Romano

Atanasković-Marković

Barbaud

et al. 2020

Allergy

236

373

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A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with betalactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost-effective, as pos-Mono

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Section: Diagnosismentioning

confidence: 99%

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Romano

Atanasković-Marković

Barbaud

et al. 2020

Allergy

236

373

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“…Finally, the review focused on adults rather than children and included cases with non‐immediate reactions as well as desquamative rashes in which skin tests have a controversial role . Given the limitations described above, the conclusion does not seem to be supported by the data reviewed and we believe that a more accurate estimate is reported by Ibanez et al…”

Section: Whether To Test With a History Of An Immediate Reaction To Amentioning

confidence: 94%

“…In the study by Mill et al of 818 children with suspected amoxicillin allergy who were evaluated by graded DPT without pre‐emptive skin testing, only 2.1% of patients had an immediate reaction, all of which were mild (urticaria) and resolved within a few hours . The Ibanez study had revealed similar rates of reactions that were all mild and limited to the skin . Of note, in the Ibanez et al study severe anaphylaxis (involving hypoxia, hypotension or neurologic compromise) was an exclusion criterion.…”

Section: Whether To Test With a History Of An Immediate Reaction To Amentioning

confidence: 99%

“…Two recent paediatric studies by Mill et al and by Ibanez all in North America and in Europe, respectively, reveal low sensitivity (less than 20%) of skin testing in the assessment of immediate reactions to amoxicillin in children (Table ) . The low sensitivity demonstrates the poor ability of the test to detect true allergy (low true positive test rates among all those who have amoxicillin allergy according to drug challenge) and argues against the use of skin testing prior to DPT.…”

Section: Whether To Test With a History Of An Immediate Reaction To Amentioning

confidence: 99%

“…For example, a study of 783 children aged 1‐14 with symptoms of a reaction to beta‐lactam antibiotics (with amoxicillin the most commonly implicated beta‐lactam) found the PPV of skin testing in those with a history of an immediate reaction to be only 22.22%, while the PPV of DPT was 55.56% . Further a more recent paediatric challenging all 732 children (mean age = 6 years) that had skin tests (and specific IgE levels), it was reported that 80% had a false‐positive skin test and that the positive predictive value (the % of true allergy among those with positive skin test) was only 23% . The latter again argues against the use of the skin test prior to DPT in the paediatric population.…”

Section: Whether To Test With a History Of An Immediate Reaction To Amentioning

confidence: 99%

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Should testing be initiated prior to amoxicillin challenge in children?

Abrams

Ben‐Shoshan

2019

Clin Experimental Allergy

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Amoxicillin is the most common antibiotic prescribed in children with increasing use over time. While up to 10% of children are labelled as amoxicillin allergic, most children can tolerate amoxicillin after allergy evaluation. It is well documented that the label of amoxicillin allergy in children is associated with adverse health outcomes such as antibiotic-resistant infections. However, it remains controversial how best to assess children for amoxicillin allergy. While in general it is recommended that skin testing be done prior to drug provocation test in the evaluation of amoxicillin allergy, there is increasing evidence that drug provocation testing could be done in lower risk children without skin testing prior. The goal of this article as a narrative review is to review the strengths and limitations of skin testing prior to drug provocation test in children who have a history of either immediate or non-immediate, reactions to amoxicillin. K E Y W O R D Sanaphylaxis, drug allergy, immunologic tests

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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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Prospective assessment of diagnostic tests for pediatric penicillin allergy

Cited by 77 publications

References 30 publications

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Should testing be initiated prior to amoxicillin challenge in children?

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

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