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.

scholarly journals The Contradiction of Drug Allergy in Patients with Cystic Fibrosis and Review of the Literature

2021 ◽  
Author(s):  
Gokcen Dilsa Tugcu ◽  
Nagehan Emiralioğlu ◽  
Ebru Yalçın ◽  
Umit Sahiner ◽  
Deniz Doğru ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Drug Allergy ◽  
Drug Hypersensitivity ◽  
Skin Tests ◽  
Beta Lactam ◽  
Provocation Tests ◽  
Maculopapular Eruption ◽  
Drug Hypersensitivity Reactions ◽  
Amoxicillin Clavulanic Acid ◽  
Multiple Drugs

Background: Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there is conflicting data about true prevalence of drug allergy in children with CF. Methods: The suspicious drug hypersensitivity reactions (DHR) of children with CF were enquired by European Network for Drug Allergy (ENDA) questionnaire and skin tests and/or drug provocation tests were performed according to established guidelines. Results: Two hundred and nineteen children (48.9% boys; median [IQR] age, 8.4 years [4.8-12.4 years]) with cystic fibrosis were included in the study, from whom 22 patients with 24 suspected DHRs were evaluated. Most of the suspected DHRs were non-immediate (n=16, 66.6%) type and the offending drugs were amoxicillin clavulanic acid (n=7), macrolides (n=4), trimethoprim sulfamethoxazole (TMP/SMX) (n=2), piperacillin tazobactam (n=1), pancrelipase (n=1) and ursodeoxycholic acid (n=1). Eight (33.3%) of the DHRs were classified as immediate [ceftriaxone (n=2), ceftazidim (n=2), meropenem (n=1), ambisome (n=2), vancomycin (n=1)]. The main presenting clinical presentations were maculopapular eruption (41.6%) and urticaria (37.5%), accompanied by angioedema (8.3%), flushing (12.5%) and vomiting (8.3%). Nine skin tests (with beta-lactam protocol in 6 patients) and 24 DPTs were performed and none of the skin tests revealed a positive result, however 2 DPTs with TMP/SMX were positive. Conclusion: Actual drug allergy was demonstrated in 2 of 219 patients (0.9%) with nonbeta-lactam antibiotics. These results conflict with previous researches that showed higher drug allergy rates but were consistent with some recent studies. Numerous and long-term use of multiple drugs during management of cystic fibrosis may contribute to tolerance development.

scholarly journals PATTERNS OF RESPONSE AND DRUGS INVOLVED IN HYPERSENSITIVITY REACTIONS TO BETA-LACTAMS IN CHILDREN.

2021 ◽  
Author(s):  
Isabel Torres-Rojas ◽  
Diana Perez ◽  
Maria Luisa Somoza-Alvarez ◽  
Elisa Haroun Diaz ◽  
Ana María Prieto-Moreno Pfeifer ◽  
...  
Keyword(s):  
Clavulanic Acid ◽  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Penicillin G ◽  
Hypersensitivity Reactions ◽  
Beta Lactams ◽  
Provocation Tests ◽  
Drug Challenge ◽  
Immediate Reactions

Background Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. Methods Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and nonimmediate reactions. The work-up included sIgE, skin testing and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for nonimmediate ones. Results Of the 510 included children, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%). Among nonimmediate reactions (11,4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6–7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities. Conclusions There were few confirmed cases of either type of reaction. Skin testing proved less valuable in nonimmediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have nonimmediate reactions, while clavulanic acid-selectivity was exclusive to the nonimmediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation.

scholarly journals Immediate Reactions to Iodinated Contrast Media Prevalence of IgE-mediated Hypersensitivity

2020 ◽  
Author(s):  
Juliette Caron ◽  
Maxime SEYNAVE ◽  
Sahara GRAF ◽  
Tomas MORALY ◽  
Christine DELEBARRE-SAUVAGE
Keyword(s):  
Contrast Media ◽  
Skin Testing ◽  
Skin Tests ◽  
Iodinated Contrast Media ◽  
Provocation Tests ◽  
Iodinated Contrast ◽  
Intradermal Tests ◽  
Ige Mediated ◽  
Low Prevalence ◽  
Work Up

Abstract BackgroundAfter administration of iodinated contrast media (ICM) some patients develop an immediate hypersensitivity reaction (IHR). A specific allergic IgE-mediated mechanism may be involved. ObjectiveTo determine the prevalence of allergic patients among ICM reactors and to evaluate the negative predictive value (NVP) of skin testing for ICM.MethodsAll patients who attended a single center for an allergy work-up between 2010 and 2019 due to a prior IHR after an ICM injection were included retrospectively. ICM allergy was diagnosed if prick tests or intradermal tests were positive. Further information concerning secondary exposure to ICM was obtained from all patients with negative skin tests to determine whether ICM re-exposure led to an IHR.ResultsSkin tests identified ICM allergy in 7 out of 85 patients (8.2%). Frequency of IgE-mediated hypersensitivity among patients increased with increasing reaction severity. The NPV of skin testing for ICM allergy was 87.8% [95%CI 75.2;95.4.ConclusionThe low prevalence of IgE-mediated hypersensitivity among patients with IHR to ICM should not delay allergy workup. Earlier skin tests and provocation tests with skin-test negative ICM may help allergists to find a reliable alternative ICM.

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 Mild to moderate hypersensitivity reactions to beta-lactams in children: a single-centre retrospective review

2019 ◽  
Vol 3 (1) ◽  
pp. e000435 ◽  
Author(s):  
Leticia Vila ◽  
Vanesa Garcia ◽  
Oihana Martinez Azcona ◽  
Loreley Pineiro ◽  
Angela Meijide ◽  
...  
Keyword(s):  
Drug Hypersensitivity ◽  
Skin Tests ◽  
Penicillin G ◽  
Hypersensitivity Reactions ◽  
Beta Lactam ◽  
Patch Tests ◽  
Provocation Tests ◽  
Delayed Reactions ◽  
Diagnostic Work ◽  
Low Sensitivity

ObjectiveBeta-lactam (BL) antibiotics are the most reported drugs in hypersensitivity reactions in children. More than 90% of these children tolerate the suspected drug after diagnostic work-up. Skin tests (STs) show low sensitivity. Our aim was to assess the performance of drug provocation tests (DPTs) without previous ST in mild and moderate delayed reactions and to propose a new DPT protocol.Design of the studyCharts from 213 children under 15 years of age referred for suspected BL allergy from 2011 to 1013 were reviewed. Prick, intradermal and patch tests were performed with major determinant penicilloyl-polylysine, minor determinant mixture, amoxicillin (AMX), cefuroxime, penicillin G and AMX–clavulamate. Children with negative skin tests underwent DPT. After an initial full dose of antibiotic, DPT was carried on for 3 days at home in patients reacting within the first 3 days of treatment. If the reaction took place from day 4 on of treatment, patients took the antibiotic for 5 days.ResultsWe included 108 girls and 105 boys. Mean age at the time of reaction was 3.66±3.06 years. 195 patients (91.5%) reacted to one BL. 154 reactions (67.2%) were non-immediate. Mild to moderate skin manifestations were most frequently reported. AMX–clavulanate was the most frequently involved (63.4%). DPT confirmed the diagnosis of drug hypersensitivity in 17 (7.3%) cases. These 17 patients had negative ST.ConclusionIn mild and moderate cases of BL hypersensitivity, diagnosis can be performed by DPT without previous ST

scholarly journals Features of in vivo diagnostics of delayed drug hypersensitivity to beta-lactams

2018 ◽  
Vol 15 (4) ◽  
pp. 30-42
Author(s):  
T S Romanova ◽  
T N Myasnikova ◽  
T V Latysheva
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Correct Diagnosis ◽  
False Negative ◽  
Skin Tests ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Presumptive Diagnosis ◽  
Minimum Age

Background. Beta-lactams are the most widely used group of antibacterial agents. They are used for treating of infectious complications of varying severity, including urgent situations. The exclusion of the entire beta-lactam group not only leads to a significant increase in the cost of treatment, length of hospitalization and the formation of resistance of the flora to alternative antibiotics, but also may be life threatening in some cases. Therefore, correct diagnosis and establishement of the offending medication can prevent the development of allergic reactions and to avoid unreasonable lifelong bans on the use of certain medications, which often lead to a decrease of the effectiveness of treatment and increase its cost. The aim of the study was to develop the diagnostic and management algorithm and of of patients with presumptive diagnosis of delayed drug hypersensitivity to beta-lactams. Materials and methods. A comprehensive in-depth examination, including in vivo tests with beta-lactams was done in 53 patients (37 - 70% women, and 16 - 30% men) with a presumptive diagnosis of delayed drug hypersensitivity to beta-lactams. The minimum age at the time of the reaction was 4 years, the maximum age was 86 years, the average age was 37 years,the median was 38,5 years old. The minimum age at the time of testing was 6 years, the maximum age was 89 years, the average age was 44 years, median was 44 years old. Results. In the group of patients with delayed drug hypersensitivity to beta-lactams (n=21) the diagnosis was confirmed by skin testing in 19 (90,5%) patients, in 18 (85,7%) to aminopenicillins, and 1 (4,8%) to ceftriaxone. In 2 (9,5%) cases, the diagnosis was established using a drug provocation test: for amoxicillin (4,8%) and for ceftriaxone (4,8%). According to the obtained data, the specificity of skin tests for the diagnostics of delayed drug hypersensitivity to beta-lactams was 100%. In case of delayed drug hypersensitivity to aminopenicillins, the sensitivity of skin tests was 94,7%, the negative predictive value of skin tests was 93,7%, the overall accuracy of skin testing was 97%, and the incidence of false-negative results was 5,3%. Conclusion. Skin testing is promising and safe in the diagnositics of delayed drug hypersensitivity to beta-lactams. It allows to exclude unreasonable contraindications for the use of beta-lactams, thereby increasing the effectiveness of treatment while reducing economic costs.

Skin tests for the exploration of hypersensitivity reactions associated with iodinated contrast media

2021 ◽  
Vol 16 ◽  
Author(s):  
Ahmed Zaiem ◽  
Syrine Ben Hammamia ◽  
Fares Ben Salem ◽  
Ons Charfi ◽  
Imen Aouinti ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hypersensitivity Reaction ◽  
Contrast Media ◽  
Skin Testing ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast ◽  
Intradermal Tests ◽  
The One

Background: Iodinated contrast media (ICM) are responsible for multiple side effects, especially hypersensitivity reactions. These reactions can either be authentic allergies, or non-allergic hypersensitivity reactions. Skin tests (prick and intradermal tests) are simple to perform and can be of great help, especially if the ICM need to be re-used. The aim of the study was to assess the characteristics of the patients in whom skin tests were performed, and the results of these tests. Methods: This is a retrospective study from June 2014 to June 2019. All included patients had at least one episode of hypersensitivity reaction to ICM and underwent skin tests. Results : We included 35 patients aged 18 to 85 years. The iopromide was the most implicated ICM. The reactions were mainly cutaneous (n=30) and immediate (n=27). The skin tests were negative, except for two patients. The reuse of ICM occured in 11 patients: 9 with an ICM other than the one suspected and two patients with the same ICM. Among these patients, 5 did not have any premedication. Two of them had a second hypersensitivity reaction, the first with another ICM and the second with the same ICM. Conclusion: One of the main pillars of allergic exploration is ICM skin testing, not only to prevent recurrence, but also to allow patients to benefit from ICM reuse, which are sometimes essential.

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 Hypersensitivity reactions to non-steroidal anti-inflammatory drugs: results of an Austrian cohort study

2020 ◽  
Vol 29 (7) ◽  
pp. 227-232
Author(s):  
Teresa Bangerl ◽  
Brigitte Zahel ◽  
Andrea Lueger ◽  
Emmanuella Guenova ◽  
Irena Angelova-Fischer ◽  
...  
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Clinical History ◽  
University Hospital ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Culprit Drug ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Summary Background Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of drug hypersensitivity. Despite the importance of NSAIDs in routine analgesia only few studies have systematically addressed the question of tolerability in hypersensitive patients. Methods The authors retrospectively analysed 398 patients that were treated at the Department of Dermatology, Kepler University Hospital Linz, Austria, in the period 2012–2016 with a clinical history of NSAID hypersensitivity. Skin tests (skin prick and intracutaneous tests) to common NSAIDs were performed, followed by single-blinded, placebo-controlled drug challenge with either the culprit drug or an alternative NSAID. Results A total of 361 patients were subjected to skin testing. Of these, 25 patients (6.3%) showed a positive reaction to the culprit drug. According to the severity of the reaction in the medical history, 87 patients were exposed orally to the culprit drug (oral provocation test, OPT) after negative skin test and 255 patients received OPT with alternative NSAIDs according to established protocols. OPT with the culprit drug resulted in hypersensitivity reactions in 12 patients (13.79%). In terms of alternative NSAID testing, the three most commonly tested drugs were lornoxicam (192 OPTs), acetaminophen (156 OPTs) and celecoxib (133 OPTs) with tolerability rates in respectively 88.54% (hypersensitivity reactions, 11.46%), 92.31% (hypersensitivity reactions, 7.69%) and 91.73% (hypersensitivity reactions, 8.27%) of cases. Conclusion OPT with alternative NSAIDs are useful in patients with NSAID hypersensitivity as tolerability varies between the individual substances.

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

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