The Association Between Risk Stratification Models And The Likelihood of Positive Penicillin Skin Tests

Kuder, Margaret; McDonnell, J. A. M.; Weller, Katherine; Wang, Xiaofeng; Li, Manshi; Lang, David M.

doi:10.1016/j.jaci.2020.12.095

Cited by 3 publications

(3 citation statements)

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“…Other tests were requested prior to DPT in only 177 patients (8.3%), conditioned both by the usual practice in the different centers and by some patient factors, such as age, immediacy and severity of the reaction, or history of more than one suspected episode. However, a positive result was obtained in only seven previous skin tests and in only one specific IgE determination, which confirms their poor performance and doubtful positive predictive value 31,49 . As in most of the published pediatric series, our results showed tolerance to the drug involved in most cases (90.9%), while allergy was confirmed in only 3.4% and unverified in the remaining 5.8%.…”

Section: Discussionsupporting

confidence: 60%

Direct oral challenge for immediate and non‐immediate beta‐lactam allergy in children: A real‐world multicenter study

Moral,

Toral,

Muñoz

et al. 2024

Pediatric Allergy Immunology

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BackgroundAllergy to beta‐lactam antibiotics (BLA) is frequently suspected in children, but a drug provocation test (DPT) rules it out in over 90% of cases. Direct oral DPT (DODPT), without skin or other previous tests, is increasingly been used to delabel non‐immediate BLA reactions. This real‐world study aimed to assess the safety and effectiveness of DODPT in children with immediate and non‐immediate reactions to BLAs.MethodsAmbispective registry study in children (<15 years), attended between 2016 and 2023 for suspected BLA allergy in 15 hospitals in Spain that routinely perform DODPT.ResultsThe study included 2133 patients with generally mild reactions (anaphylaxis 0.7%). Drug provocation test with the implicated BLA was performed in 2014 patients (94.4%): 1854 underwent DODPT (86.9%, including 172 patients with immediate reactions). One hundred forty‐five (7.2%) had symptoms associated with DPT, although only four reactions were severe: two episodes of anaphylaxis and two of drug‐induced enterocolitis syndrome, which resolved rapidly with treatment. Of the 141 patients with mild reactions in the first DPT, a second DPT was considered in 87 and performed in 57, with 52 tolerating it without symptoms. Finally, BLA allergy was ruled out in 90.9% of the sample, confirmed in 3.4%, and remained unverified, usually due to loss to follow‐up, in 5.8%.ConclusionsDirect oral DPT is a safe, effective procedure even in immediate mild reactions to BLA. Many reactions observed in DPT are doubtful and require confirmation. Severe reactions are exceptional and amenable to treatment. Direct oral DPT can be considered for BLA allergy delabeling in pediatric primary care.

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Section: Discussionsupporting

confidence: 60%

Direct oral challenge for immediate and non‐immediate beta‐lactam allergy in children: A real‐world multicenter study

Moral,

Toral,

Muñoz

et al. 2024

Pediatric Allergy Immunology

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“…The positive predictive value has classically been considered low when the prevalence of penicillin hypersensitivity is low. Therefore, in these populations, false positives can arise [11,[18][19][20].…”

Section: General Datamentioning

confidence: 99%

How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem

Tejedor-Alonso,

Perez-Encinas,

Sanz Márquez

et al. 2024

J Investig Allergol Clin Immunol

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Background: Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of false-negative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non–ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less “ultrarapid” strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.

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“…They found penicillin allergy testing to be cost saving, with a net benefit ranging from $256 to $6745 for inpatients and outpatients, respectively. Protocols for penicillin allergy testing are well established, the cost of testing has been previously characterized in detail [16], and testing has been shown to be safe for pregnant women [17][18][19]. Considering pregnancy care and the delivery hospitalization, including GBS antimicrobial susceptibility testing, we compared the cost of usual care to the cost of a test then treat strategy for all pregnant women who report a penicillin allergy.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the cost-effectiveness of testing pregnant women for penicillin allergy

et al. 2023

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Introduction True penicillin allergy is rare and is commonly incorrectly reported. In fact, less than five percent of patients who report a penicillin allergy will have a currently active clinically-significant IgE- or T-cell-mediated hypersensitivity when appropriately tested. Penicillin is the agent of choice for intrapartum antibiotic prophylaxis to reduce the risk of group B streptococcus early-onset disease in the newborn. Inaccurate penicillin allergy status may lead to inappropriate antibiotic use, as most alternative drugs are more expensive and broader spectrum than penicillin. Penicillin allergy testing has been found to be safe in pregnancy and cost-effective in other patient populations. Objective To evaluate the cost-effectiveness of penicillin allergy testing and appropriate antibiotic treatment (test then treat strategy) compared to usual care among pregnant women. Methods We developed a decision tree to evaluate the cost of providing appropriate care via a test then treat strategy for pregnant women who report a penicillin allergy, compared to usual care. Results Using the test then treat strategy the additional cost to ensure appropriate care for all pregnant women who report a penicillin allergy, was $1122.38 per person. Adopting a test then treat strategy increased the number of appropriate antibiotic use from 7,843/10,000 to 10,000/10,000 simulations. Conclusion Our results show that a test then treat strategy for pregnant women who report a penicillin allergy is a good-value intervention.

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The Association Between Risk Stratification Models And The Likelihood of Positive Penicillin Skin Tests

Cited by 3 publications

References 0 publications

Direct oral challenge for immediate and non‐immediate beta‐lactam allergy in children: A real‐world multicenter study

Direct oral challenge for immediate and non‐immediate beta‐lactam allergy in children: A real‐world multicenter study

How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem

Evaluating the cost-effectiveness of testing pregnant women for penicillin allergy

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