Direct Challenges for the Evaluation of Beta-Lactam Allergy: Evidence and Conditions for Not Performing Skin Testing.
| Autor: | Iammatteo M; Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Bronx, NY., Lezmi G; AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France; Equipe Immunorégulation et Immunopathologie, Institut Necker Enfants Malades, Inserm UMR1151, CNRS UMR8253, Université de Paris, Paris, France., Confino-Cohen R; Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Tucker M; Department of Allergy and Immunology, Kaiser Permanente Tacoma Medical Center, Tacoma, Wash., Ben-Shoshan M; Division of Pediatric Allergy, Clinical Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada., Caubet JC; Pediatric Allergy Unit, Department of the Child and Adolescent, Geneva University Hospital, Geneva, Switzerland. Electronic address: jeanchristoph.caubet@gmail.com. |
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| Jazyk: | angličtina |
| Zdroj: | The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2021 Aug; Vol. 9 (8), pp. 2947-2956. |
| DOI: | 10.1016/j.jaip.2021.04.073 |
| Abstrakt: | 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. (Copyright © 2021 American Academy of Allergy, Asthma & Immunology. All rights reserved.) |
| Databáze: | MEDLINE |
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