75% negative skin test results in patients with suspected hypersensitivity to beta-lactam antibiotics: Influencing factors and interpretation of test results
| Autor: | Benno Schnyder, Anna Gschwend, Arthur Helbling, Cordula Meincke, Peter Schmid-Grendelmeier, Michelle Heilig, Thierry M Nordmann, Martin Glatz, Susann Hasler, Lukas Joerg |
|---|---|
| Přispěvatelé: | University of Zurich, Joerg, Lukas |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Allergy Lymphocyte transformation test Basophil activation test Provocation test Drug allergy Immunology 610 Medicine & health Penicillins Patch test Gastroenterology Article Skin test Intradermal skin test T-cell Internal medicine medicine Immunology and Allergy Beta-lactams Adverse effect Anaphylaxis 2403 Immunology Angioedema business.industry Maculopapular exanthema Amoxicillin 10177 Dermatology Clinic RC581-607 medicine.disease Cephalosporins Negative Skin Test 2740 Pulmonary and Respiratory Medicine Drug provocation test 2723 Immunology and Allergy IgE medicine.symptom Immunologic diseases. Allergy business Drug hypersensitivity |
| Zdroj: | World Allergy Organization Journal, Vol 14, Iss 11, Pp 100602-(2021) Jörg, Lukas; Hasler, Susann; Gschwend, Anna; Meincke, Cordula; Nordmann, Thierry M.; Glatz, Martin; Heilig, Michelle; Schnyder, Benno; Helbling, Arthur; Schmid-Grendelmeier, Peter (2021). 75% negative skin test results in patients with suspected hypersensitivity to beta-lactam antibiotics: Influencing factors and interpretation of test results. World Allergy Organization journal, 14(11), p. 100602. Elsevier 10.1016/j.waojou.2021.100602 The World Allergy Organization Journal |
| DOI: | 10.1016/j.waojou.2021.100602 |
| Popis: | Background The diagnostic approach for beta-lactam (BL) drug hypersensitivity reactions (DHR) is based on the history, clinical signs, skin tests (ST), in vitro tests, and drug provocation tests (DPT). The aim of this study was to assess the performance of an allergy workup with ST in a real-world use. Methods In this cross-sectional study the rate of positive ST in subjects with suspected DHR to penicillins and cephalosporins was investigated. Of special interest were correlations of ST positivity: 1) to the time intervals between index reaction and the allergic work-up, 2) time interval from drug exposure to the onset of signs, 3) pattern of manifestation in delayed DHR and involvement of test area in the index reaction, and 4) potential advantage of patch testing in delayed DHR. Results 175 patients were included between January 2018 and April 2019 (63.4% female), 45 (25.7%) with immediate DHR manifestation and 130 with delayed DHR manifestation (74.3%). A total of 44 patients (25.1%) had a positive ST (immediate DHR 37.8% versus 20.0% in delayed DHR). ST positivity decreased in both groups after 3 years from 47.8% [95%CI 29.2–67] to 23.5% [95%CI 9.6–47.3] in immediate DHR and 23.0% [95%CI 15-4-32.9] to 12.9% [95%CI 5.1–28.9] in delayed DHR. The proportion of positive ST was higher in patients with more severe forms of delayed DHR, and in subjects with a shorter latency period of onset of symptoms after drug exposure: 0-3d: 29.5% [95%CI 19.6–41.9] vs. >3d: 11.6% [95%CI 6.0–21.2]). No sensitization was shown in delayed urticaria or angioedema. ST done outside the skin area involved during the index reaction were negative in all cases (0/38 vs. 26/84 in cases with involved area). The combination of patch test and intradermal test (IDT) revealed an additional positive result in 2/77 cases. Additional in vitro testing reduced the proportion of negative test results to 72%. Conclusion In most patients with negative test results, we could not clarify the cause of the BL-associated adverse events even with further investigations (including DPT). How to prevent new drug-induced adverse events in such patients has hardly been investigated yet. Corresponding cohort studies could improve the data situation. |
| Databáze: | OpenAIRE |
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