To challenge or not to challenge: Literature data on the positive predictive value of skin tests to beta-lactams

Chiriac, Anca Mirela; Vasconcelos, Maria-Joao; Izquierdo, Lisa; Ferrando, Laetitia; Nahas, Olga; Demoly, Pascal

doi:10.1016/j.jaip.2019.01.060

Cited by 11 publications

(8 citation statements)

References 81 publications

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“…This may explain why the PPVs projected by our models were lower than those estimated by a recent review, which identified a PPV of 81%. 126 However, that latter review included only studies with detailed characterizations of each participant's index reaction (and tested with the culprit drug), who, as such, had a higher pretest probability of having a true/severe allergic reaction. Although we were not able to estimate the diagnostic accuracy of skin tests and specific IgE for each clinical presentation or risk group, 127 we were able to estimate the sensitivity, specificity, and predictive values for penicillin skin tests in patients reporting a delayed maculopapular exanthema or urticaria/angioedema.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis

Sousa‐Pinto

Tarrio

Blumenthal

et al. 2021

Journal of Allergy and Clinical Immunology

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Section: Discussionmentioning

confidence: 99%

Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis

Sousa‐Pinto

Tarrio

Blumenthal

et al. 2021

Journal of Allergy and Clinical Immunology

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“…Then, as for any suspected immediate hypersensitivity reaction, the clinician uses tools (eg ST, sIgE, DPT) to test the different suspected culprits. Although the investigation of different culprits relies mostly on different combinations of tests (eg ST and DPT for antibiotics, analgesics; ST and sIgE for latex, chlorhexidine and quaternary ammonium), there is evidence that has accumulated over several decades that provides valuable insight into the value of these tests, including PPV of ST (eg beta‐lactam antibiotics), 24 NPV of ST (eg beta‐lactam antibiotics, NMBAs, morphinics) 25–27 and NPV of DPT (eg beta‐lactam antibiotics, analgesics) 28 . However, to establish a final diagnosis, more complex reasoning come into play because manifestations resembling anaphylaxis may be elicited by intrinsic pharmacological effects of drugs and factors related to the anaesthetic and/or surgical management, or to the state of the patient at the time of the administration of general anaesthesia (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of serial serum total tryptase measurement to differentiate positive from negative allergy testing among patients with suspected perioperative hypersensitivity

Srisuwatchari

Tacquard

Borushko

et al. 2021

Clin Experimental Allergy

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Background Serum total tryptase has been shown to increase during acute allergic reactions (acute tryptase, TA); however, few studies have investigated the values of TA or a combination of TA and baseline tryptase (TB) to discriminate positive from negative testing in perioperative hypersensitivity reaction (POH) allergy work‐up. The aim of this study was to determine the diagnostic performance of TA in order to differentiate positive from negative allergy testing suspected POH and analyse the diagnostic performance of serial tryptase levels using several formulas. Methods All patients from the University hospital of Montpellier and Strasbourg, France, who presented with suspected POH and underwent complete drug allergy work‐up between March 2011 and December 2019 with available TA and TB were included. Four formulas, including a change in TA > 11 (F1), or >2 + 1.2 × TB (F2), or >3 + TB (F3), or >120%TB (F4), were applied. Results One hundred and sixty‐two patients were included, and 131 of them (80.8%) had Grade III or IV reactions. Ninety patients had positive allergy testing. The optimal cut‐off value of TA to distinguish positive from negative allergy testing patients was 9.8 μg/L with an AUC of 0.817 (95% CI: 0.752–0.882, p < .001). The 93% PPV threshold for TA was 33 μg/L (95.8% specificity). Paired tryptase levels according to formulas F2 and F3 yielded the highest Youden index (0.54 and 0.53, respectively). Conclusion The optimal cut‐off point for TA for distinguishing positive from negative allergy testing suspected POH was 9.8 μg/L. TA value of 33 μg/L was required to achieve >90% PPV.

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“…The concept that premedication will not prevent a reaction in patients with a type I allergy is generally accepted but largely based on extrapolation from other studies [63]. Recently, iatrogenic re-exposures to skin test-positive ICM suggest a high positive predictive value [64].…”

Section: Premedication Studiesmentioning

confidence: 99%

Premedication for Iodinated Contrast Media Induced Immediate Hypersensitivity Reactions

Schrijvers

Démoly

Chiriac

2019

Curr Treat Options Allergy

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Purpose of the review Premedication using antihistamines and/or corticosteroids has been widely used to prevent reoccurrence of immediate hypersensitivity reactions (iHR) after iodinated contrast media (ICM). However, efficacy has been debated, especially in high-risk patients. Novel findings on the role and risks of premedication and preventive strategies are summarized. Recent findings The rate and severity of iHR occurring despite premedication indicate that premedication is not a panacea and the intensity usually reflects that of the initial reaction. Next, the number needed to treat (NNT) to prevent one serious ICM-mediated event using corticosteroid-based premedication is high and associated with a diagnostic delay. Randomly changing the ICM has been suggested as an additional preventive measure, whilst others used a skin test-based approach to identify a subgroup of ICM allergic patients and negative skin test-based alternatives with a high negative predictive value. Summary Growing evidence indicates the need to discriminate between non-allergic iHR that are most likely non-obligatory and susceptible to premedication, and rare type I allergic iHR

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To challenge or not to challenge: Literature data on the positive predictive value of skin tests to beta-lactams

Cited by 11 publications

References 81 publications

Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis

Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis

Diagnostic performance of serial serum total tryptase measurement to differentiate positive from negative allergy testing among patients with suspected perioperative hypersensitivity

Premedication for Iodinated Contrast Media Induced Immediate Hypersensitivity Reactions

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