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
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:
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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