Safety and cost effectiveness of supervised ambulatory drug provocation tests in children with mild non‐immediate reactions to beta‐lactams

Jaoui, Ariane; Delalande, D.; Siouti, S.; Benoist, G.; Seve, Edouard; Ponvert, C.; Scheinmann, P.; Faour, Hassan; Neuraz, Antoine; Garcelon, Nicolas; Delacourt, Christophe; Lezmi, Guillaume

doi:10.1111/all.13871

Cited by 16 publications

(14 citation statements)

References 8 publications

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“…All these circumstances represent not only a health problem but also a significant financial burden for affected individuals and health systems with high medical costs mainly on inpatient care. It has been considered that a correct diagnosis could save around 1145‐4254$ per patient …”

Section: The Burden Of Drug Hypersensitivitymentioning

confidence: 99%

“…It has been considered that a correct diagnosis could save around 1145-4254$ per patient. 20,21 Over recent years, mislabelling is showing to be a relevant problem in two ways: (a) false label of allergic, which increment the real DHR incidence and affect the individual treatment options; (b) false In this review, we have considered these problems highlighting the recent advances about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management.…”

Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

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Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: The Burden Of Drug Hypersensitivitymentioning

confidence: 99%

Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…23,61 Others suggested that the number of days of drug administration may influence the outcome of DTP and therefore the diagnosis, but there is a great heterogeneity on the number of days recommended, ranging from 1 to 10. 9,21,26,[34][35][36][37][38]55,58,62,63 Extended protocols provide slightly higher NPV values, ranging from 89.1% in one-day DPTs 26 to 97.6% for 5day DPTs. 35,36 In addition, it has been also suggested that compliance to BLs may be increased after extended DPTs when compared with shorter protocols.…”

Section: Discussionmentioning

confidence: 94%

“…26 The pur- dose in cases reporting NIRs to BLs. 9,33,34,57 Although this procedure has been reported to be safe, reports performed without previous STs in paediatric population are scarce. 57 In our prospective study, we found no differences in the overall percentage of MPE and delayed-urticaria when we compared the original reaction with the reactions developed during the DPT and none of the children with a positive DPT reported a severe reaction at home.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, DPTs are considered the gold standard 1,3,19,23,26‐28 and recent evidence is increasingly supporting direct DPTs without STs in children with suspicion of mild NIRs to either AX or penicillin 1,3,9,29,30 . However, at present, there is no standardized DPT protocol for investigating NIRs 31 with no consensus on dosing schedule, ranging from 7 to 8 step escalating dose 32 to one single dose 9,33,34 . Moreover, there are controversies about the length of DPT protocols as prolonged drug challenges at home have been reported to provide higher negative predictive values (NPV) than shorter ones 35‐38 although with more side effects and health and cost impact 39‐41 .…”

Section: Introductionmentioning

confidence: 99%

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Single‐dose prolonged drug provocation test, without previous skin testing, is safe for diagnosing children with mild non‐immediate reactions to beta‐lactams

Prieto

Muñoz

Bogas

et al. 2021

Allergy

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Introduction: Mild non-immediate reactions (NIRs) to beta-lactams (BLs) are the most frequent manifestation of drug allergy in children. The diagnostic approach is complex as the utility of skin tests (STs) and lymphocyte transformation tests (LTTs) is controversial. Drug provocation test (DPT) is the gold standard, although no standardized protocols exist. We aimed to investigate the utility of DPT in a unique dose without previous STs, and LTTs in the diagnosis of NIRs to BLs in children. Methods:We prospectively evaluated children 0-14 years old referred to the Regional University Hospital of Málaga during 2017-2020 reporting NIRs to BLs. We performed a DPT with a unique dose followed by regular treatment at home. If positive, STs and LTTs were done after the reaction had disappeared. Results:We included 194 children, having 24 (12.4%) a positive DPT. The main culprit was AX (70.1%) followed by AX-clavulanic acid (CLV) (26.8%) and the main symptoms maculopapular exanthema (MPE) (49.5%) and delayed-urticaria (48.5%). A decrease (p = 0.013) in the interval of days between drug administration and onset of symptoms was observed in positive DPT compared with the original reaction (3.5 vs 6 days), with no differences in the overall percentage of MPE and delayed-appearing urticaria (p = 0.551). No severe reactions occurred during DPT. Moreover, STs were positive in 13.33% and LTTs in 52.9%. Conclusions:Single-dose DPT without previous STs is a safe and useful way to assess NIRs to BLs in children. LTT has shown to be useful, confirming a T-cell mechanism involved in these reactions.

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Delabelling Antibiotic Hypersensitivity in Children Is Critical for Future Treatments

Soyer

2020

Curr Treat Options Allergy

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Safety and cost effectiveness of supervised ambulatory drug provocation tests in children with mild non‐immediate reactions to beta‐lactams

Cited by 16 publications

References 8 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

Single‐dose prolonged drug provocation test, without previous skin testing, is safe for diagnosing children with mild non‐immediate reactions to beta‐lactams

Delabelling Antibiotic Hypersensitivity in Children Is Critical for Future Treatments

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