Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta‐analysis
Autor: | Anca Mirela Chiriac, Kimberly G. Blumenthal, Bernardo Sousa-Pinto, Isabel Tarrio, Luís Filipe Azevedo, David Afonso-João, António Cardoso-Fernandes, João Fonseca, Luís Delgado |
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Přispěvatelé: | Universidade do Porto, Massachusetts General Hospital [Boston], Harvard Medical School [Boston] (HMS), Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidemiology of Allergic and Respiratory Diseases Department [Paris] (EPAR), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Universidade do Porto = University of Porto, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHIRIAC, Anca Mirela |
Rok vydání: | 2021 |
Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Allergy [SDV.IMM] Life Sciences [q-bio]/Immunology [SDV]Life Sciences [q-bio] Immunology Provocation test Drug allergy Culprit 03 medical and health sciences 0302 clinical medicine systematic review Internal medicine anaphylaxis medicine Credible interval Immunology and Allergy 030212 general & internal medicine penicillin allergy adverse drug reactions business.industry Research drug challenge RC581-607 medicine.disease 3. Good health Penicillin 030228 respiratory system drug provocation test Meta-analysis [SDV.IMM]Life Sciences [q-bio]/Immunology Bayesian meta-analysis Immunologic diseases. Allergy Bayesian meta‐analysis business drug allergy Anaphylaxis medicine.drug |
Zdroj: | Clinical and Translational Allergy Clinical and Translational Allergy, BioMed Central, 2021, 11 (4), pp.e12008. ⟨10.1002/clt2.12008⟩ Clinical and Translational Allergy, Vol 11, Iss 4, Pp n/a-n/a (2021) Clinical and Translational Allergy, BioMed Central, 2021, 11 (4), ⟨10.1002/clt2.12008⟩ |
ISSN: | 2045-7022 |
Popis: | International audience; Background: Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold-standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other β-lactams.Methods: We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta-analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses.Results: We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%-0.13%; I2 = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non-immediate index reactions (OR = 0.05; 95% CrI = 0-0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7-21.5; I2 = 0.3%). Performance of direct DPTs in low-risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions.Conclusions: In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life-threatening index reactions or patients with positive skin tests-who were mostly not assessed in this analysis -, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy. |
Databáze: | OpenAIRE |
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