Delayed positive drug provocation tests to beta‐lactams with flare‐up reactions of skin tests sites

2020 ◽  
Author(s):  
Sabela Pérez‐Codesido ◽  
Jean‐Luc Bourrain ◽  
Pascal Demoly ◽  
Anca‐Mirela Chiriac
Keyword(s):  
Skin Tests ◽  
Beta Lactams ◽  
Provocation Tests ◽  
Drug Provocation Tests

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

Allergy ◽  
2019 ◽  
Vol 74 (12) ◽  
pp. 2482-2484 ◽  
Author(s):  
Ariane Jaoui ◽  
Delphine Delalande ◽  
Souha Siouti ◽  
Grégoire Benoist ◽  
Edouard Sève ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Beta Lactams ◽  
Provocation Tests ◽  
Drug Provocation Tests ◽  
Immediate Reactions

Diagnostic value and safety of penicillin skin tests in children with immediate penicillin allergy

2020 ◽  
Vol 41 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Ilknur Kulhas Celik ◽  
Irem Turgay Yagmur ◽  
Ozge Yilmaz Topal ◽  
Muge Toyran ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Diagnostic Value ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Provocation Tests ◽  
Test Kit ◽  
History Of ◽  
Drug Provocation Tests ◽  
Immediate Reactions

Background: The first-line method in the diagnosis of patients who describe an immediate reaction after penicillin intake is a skin test (ST) with penicillin reagents. Objectives: We aimed to determine the safety and diagnostic value of penicillin STs in the diagnosis of immediate reactions to penicillins in pediatric patients. Methods: The study included pediatric patients with suspected immediate reaction to penicillin who were subjected to STs by using a standard penicillin test kit as well as suspected penicillin and the drug provocation tests (DPT) with the suspected penicillin at our clinic. Results: A total of 191 patients (53.9% boys) with a median age of 6.83 years (interquartile range, 4.2‐12 years) were included in the study. The time from drug intake to the onset of reaction was ≤1 hour in 138 patients (72.3%) and 1 to 6 hours in 53 patients (27.7%). Penicillin allergy (PA) was confirmed by diagnostic tests in 36 of the 191 patients (18.8%). In multivariate logistic regression analysis, the history of both urticaria and angioedema (odds ratio [OR] 27.683 [95% confidence interval {CI}, 3.143‐243.837]; p = 0.003) and anaphylaxis (OR 56.246 [95% CI, 6.598‐479.489]; p < 0.001) were the main predictors of a PA diagnosis. Although ST results were positive in 23 patients (63.8%), 13 patients (26.2%) had positive DPT results despite negative ST results. The negative predictive value (NPV) of STs was calculated 92.2% (155/168). None of our patients experienced immediate or delayed systemic and/or local reactions in relation to the STs. Conclusion: A history of urticaria with angioedema and anaphylaxis were the main predictors of true PA in children with suspected immediate reactions. STs with penicillin reagents are safe for use in children. Although STs have a high NPV, DPT is the gold standard for diagnosis. DPTs should be performed as the final step of the diagnostic evaluation of PA in patients with negative ST results.

scholarly journals Diagnosing and Managing Patients with Reactions to Radiocontrast Media

2021 ◽  
Vol 8 (3) ◽  
pp. 210-221
Author(s):  
Knut Brockow
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Positive Skin ◽  
Provocation Tests ◽  
Ring Molecules ◽  
Allergic Skin ◽  
Drug Hypersensitivity Reactions ◽  
Drug Provocation Tests

Abstract Purpose of the review Iodinated radio contrast media (RCM) belong to the most common elicitors of drug hypersensitivity reactions (HR). Urticaria or anaphylaxis may occur ≤ 1(−6) hour(s) (immediate HR) and exanthems (non-immediate HR) develop > 6 h after application of RCM. Evidence for an immunologic mechanism of RCM HR against the different RCM benzene ring molecules and the benefit of allergological testing in patients with previous hypersensitivity reactions is progressively increasing. Recent findings Positive skin tests can confirm allergy in patients with previous reactions to RCM and help to select alternative better tolerated RCMs. Severe hypersensitivity reactions are mainly caused by an allergic mechanism, whereas the majority of non-severe reactions appear to be non-allergic. Skin testing is highly recommended to help identify allergic hypersensitivity reactions and to select alternatives. Using structurally different RCM is more effective than premedication for the prevention of future reactions. Drug provocation tests to RCM have been increasingly used, but are not yet standardized among different centers. Summary In patients with previous severe hypersensitivity reactions to RCM, skin testing is recommended. For future RCM-enhanced examinations in patients with previous reactions, structurally different, skin test-negative preparations should be applied. Drug provocation tests do confirm or exclude RCM hypersensitivity or may demonstrate tolerability of alternative RCMs.

scholarly journals Macrolide Allergy in Children and the Negative Predictive Value of Drug Provocation Tests in Mild Index Reactions

2021 ◽  
Vol 19 (2) ◽  
pp. 92-99
Author(s):  
Betül Karaatmaca ◽  
Şule büyük yaytokgil ◽  
İlknur Külhaş Çelik ◽  
Özge Yılmaz Topal ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Skin Tests ◽  
Provocation Tests ◽  
Patient Reported ◽  
Drug Provocation Test ◽  
Work Up ◽  
Drug Provocation Tests

ABSTRACT Objective: Macrolide allergy is rarely reported, and there is limited knowledge of hypersensitivity reactions (HRs) in children. The negative predictive value (NPV) of drug provocation tests (DPTs) for macrolides is unresolved. We aim to evaluate the clinical features of macrolide allergy in children, and determine the NPV of macrolide DPTs. Materials and Methods: Pediatric patients who were referred to our allergy department with a suspicion of macrolide allergy were evaluated by DPTs with or without prior skin tests between 2011 and 2020. Characteristics of the HRs and patients, the results of skin and DPTs were recorded. At least three months after evaluation of the patients with allergy work up, telephone interviews were performed. Patients were asked whether they had reused the suspected macrolide or not. Patients who reported HR during subsequent drug intake were invited for reevaluation. Results: A total of 160 children (161 reactions) (55.6% male) with a suspicion of macrolide allergy were enrolled for the study, and all children had a mild index reaction. The median age was 48 (18-102) months, and the median time between the suspected allergic reaction and allergy work-up was 3 (2-8) months. The most frequently reported suspected agent was clarithromycin, in 151 patients (94.4%). Macrolide allergy was confirmed in 8 (5%) patients. Only one patient reported skin eruptions upon reuse despite a negative DPT and he was invited to be reevaluated. A second DPT was performed resulting in urticarial lesions. The NPV was found to be 97.4% for negative DPT with macrolides. Conclusion: Confirmed macrolide allergy is rare in children, and DPTs are the gold standard to assess suspected macrolide allergy. The NPV of macrolide provocation tests seems to be high in children. Keywords: Children, drug hypersensitivity, drug provocation test, macrolide, negative predictive value

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

2020 ◽  
Vol 13 (8) ◽  
pp. 100390
Author(s):  
Lezmi Guillaume ◽  
Ariane Jaoui ◽  
Delphine Delalande ◽  
Souha Siouti ◽  
Gregoire Benoist ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Beta Lactams ◽  
Provocation Tests ◽  
Drug Provocation Tests ◽  
Immediate Reactions

scholarly journals Beta-Lactam Allergy: Real Practice in a Regional Hospital

2021 ◽  
Vol 96 (1) ◽  
pp. 42-47
Author(s):  
Hyerim Kim ◽  
Jaechun Lee ◽  
Sejin Kim
Keyword(s):  
Emergency Room ◽  
Drug Administration ◽  
Bacterial Infections ◽  
Skin Tests ◽  
Beta Lactam ◽  
Provocation Tests ◽  
Inflammatory Drugs ◽  
Real Practice ◽  
Symptoms And Signs ◽  
Drug Provocation Tests

Background/Aims: Beta-lactam (BL) antibiotics are widely prescribed for controlling bacterial infections and relevant culprits of adverse drug reactions (ADRs). BL allergy may vary according to prescription patterns within a given period of time. However, BL allergy in contemporary clinical practice has rarely been a focus of research.Methods: To investigate the clinical characteristics of BL allergy, subjects with ADRs to medicines, including BL antibiotics, were retrospectively reviewed.Results: Among the 175 enrolled subjects, BL antibiotics as culprits were confirmed in 79 (45.1%, female 53.2%, age 49 ± 14 years). Among the patients with confirmed BL allergy, only two (2.5%) were diagnosed via a prescription survey completed as part of multi-drug administration. The others were confirmed by serologic tests in 33 patients (41.8%), skin tests in 29 (36.7%), and drug provocation tests in 15 (19.0%). Regarding the symptoms and signs, onset within an hour of taking medicines was common (61 patients, 77.3%). Itchy skin was most common, followed by hives, rash, breathing difficulty, angioedema, and hypotension. Anaphylaxis occurred in 67%, and one-half (50.6%) of patients visited the emergency room. Cefaclor and amoxicillin were common BL culprits. Among others who did not have BL allergy, nonsteroidal anti-inflammatory drugs were found to be common culprits, followed by quinolones.Conclusions: BL allergy is common among patients who experienced ADRs to medicines including BL antibiotics. For multi-drug administration, a prescription survey hardly helped in confirming BL allergy. Anaphylaxis is common in patients with BL allergy, frequently leading to emergency room visits. Cefaclor and amoxicillin are common culprits.

Systemic reaction during intradermal skin tests with beta-lactams

2021 ◽  
Vol 14 (3) ◽  
pp. e240050
Author(s):  
Joana Carvalho ◽  
Georgeta Oliveira
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Systemic Reaction ◽  
Skin Tests ◽  
Beta Lactam ◽  
Provocation Tests ◽  
Maculopapular Eruption ◽  
Intradermal Tests ◽  
Amoxicillin Clavulanate ◽  
Immediate Reactions

Beta-lactam (BL) antibiotics are the most frequent cause of drug hypersensitivity in children, inducing both immediate and non-immediate reactions. Here we report a case of a 4-year-old child with a disseminated maculopapular exanthema 7 days after the first dose of amoxicillin–clavulanate, referred to our paediatric allergy department. Skin prick tests were negative. Intradermal tests were performed and, after 10 hours, indurated wheals larger than 10×10 mm with progressive erythema and disseminated maculopapular eruption were developed, related to amoxicillin and amoxicillin–clavulanate. Systemic reactions to BL skin tests are rarely reported and the majority are immediate reactions. This case illustrates a rare example of a non-immediate systemic reaction to intradermal tests, underlying the importance of skin testing before drug provocation tests in cases of moderate to severe non-immediate reactions.

Outcomes of drug provocation tests in Korean children with suspected drug hypersensitivity reaction

2018 ◽  
Vol 6 (1) ◽  
pp. 26 ◽  
Author(s):  
Soo Ran Noh ◽  
Jisun Yoon ◽  
Hyun-Ju Cho ◽  
Seongyoon Song ◽  
Geun-Mi Park ◽  
...  
Keyword(s):  
Hypersensitivity Reaction ◽  
Drug Hypersensitivity ◽  
Suspected Drug ◽  
Korean Children ◽  
Provocation Tests ◽  
Drug Hypersensitivity Reaction ◽  
Drug Provocation Tests

Skin And Drug Provocation Tests In The Diagnosis Of Non-Immediate Hypersensitivity Reactions To Iodinated Contrast Media

2011 ◽  
Vol 127 (2) ◽  
pp. AB197-AB197
Author(s):  
M.J. Torres ◽  
F. Gomez ◽  
A. Rosado ◽  
I. Doña ◽  
N. Blanca-Lopez ◽  
...  
Keyword(s):  
Contrast Media ◽  
Hypersensitivity Reactions ◽  
Iodinated Contrast Media ◽  
Immediate Hypersensitivity ◽  
Provocation Tests ◽  
Iodinated Contrast ◽  
Drug Provocation Tests

Drug provocation tests in children

2018 ◽  
Vol 6 (1) ◽  
pp. 1
Author(s):  
Yang Park
Keyword(s):  
Provocation Tests ◽  
Drug Provocation Tests
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