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Scientific article
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English

Direct Challenges for the Evaluation of Beta-Lactam Allergy: Evidence and Conditions for Not Performing Skin Testing

Published inJournal of allergy and clinical immunology. In practice, vol. 9, no. 8, p. 2947-2956
Publication date2021-08
Abstract

In the western world, up to 10% of the general population and more than 15% of hospitalized patients report penicillin allergy. After a comprehensive evaluation, more than 95% of patients who report a penicillin allergy can subsequently tolerate this antibiotic. Traditionally, the most widely accepted protocol to evaluate beta-lactam (BL) allergy consisted of skin testing (ST) followed by a drug provocation test (DPT) in ST-negative patients. DPT is the gold standard for proving or excluding BL allergy and is considered the final and definitive step in the evaluation. Recently, studies have been published that support the use of direct DPTs without preceding ST for both pediatric and adult patients who report a low-risk historical reaction to BLs. However, these studies use various risk-stratification criteria to determine eligibility for a direct DPT. A standardized protocol for DPT is also lacking. In this review, we assess the current literature and evidence for performing direct DPT in the pediatric and adult populations. On the basis of this evidence, we also present risk-based algorithms for the evaluation of BL allergy in pediatric and adult populations based on a description of the historical reaction.

eng
Keywords
  • Beta-lactam allergy
  • Drug challenge
  • Drug provocation test
  • Penicillin allergy
  • Skin test
  • Adult
  • Anti-Bacterial Agents / adverse effects
  • Child
  • Drug Hypersensitivity / diagnosis
  • Humans
  • Penicillins / adverse effects
  • Skin Tests
  • Beta-Lactams / adverse effects
Citation (ISO format)
IAMMATTEO, Melissa et al. Direct Challenges for the Evaluation of Beta-Lactam Allergy: Evidence and Conditions for Not Performing Skin Testing. In: Journal of allergy and clinical immunology. In practice, 2021, vol. 9, n° 8, p. 2947–2956. doi: 10.1016/j.jaip.2021.04.073
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ISSN of the journal2213-2198
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