loading page

Skin and in vitro tests reduce the need for drug provocation tests in drug hypersensitivity to betalactams
  • +3
  • Stefan Wöhrl,
  • Christian Ostermayer,
  • Gabriele Sesztak-Greinecker,
  • Reinhart Jarisch,
  • Wolfgang Hemmer,
  • Felix Wantke
Stefan Wöhrl
Floridsdorf Allergy Center (FAZ)
Author Profile
Christian Ostermayer
Floridsdorf Allergy Center (FAZ)
Author Profile
Gabriele Sesztak-Greinecker
Floridsdorf Allergy Center (FAZ)
Author Profile
Reinhart Jarisch
Floridsdorf Allergy Center (FAZ)
Author Profile
Wolfgang Hemmer
Floridsdorf Allergy Center (FAZ)
Author Profile
Felix Wantke
Floridsdorf Allergy Center (FAZ)
Author Profile

Abstract

BACKGROUND: Many patients report questionable drug hypersensitivity reactions (DHR) to betalactams. Allergological evaluation is required for objectivation. Recently, some researchers advocated direct drug provocation tests (DPTs) omitting a prior allergy-workup. However, DPTs bare the risk of severe side effects and are a scarce resource in overloaded healthcare-systems. We investigated the value of an approach using only the broadly available methods drug-specific history, specific IgE, and skin tests without DPT. METHODS: We conducted a chart review in a retrospective cohort of 932 patients in an allergy outpatient centre from 2016-2017. Patients had been submitted to drug-specific history and specific IgE-, skin prick-, intradermal- and patch-tests with early and late readings with a series of penicillins and cephalosporins but DPTs were no option. RESULTS: Overall, positive in vitro and/or skin tests were found in 96/932 (10.3%) patients. Drug-specific IgE was detected in 40/932 (4.3%) patients, 61/787 (7.8%) patients had positive skin tests. In vitro tests to Pencillin V showed the highest rate of positivity 24/479 (5.0%) and early readings of ampicillin the highest amongst the skin tests 3/49 (6.1%). Immediate skin tests were more often positive than delayed ones (75:45). The combination of all parameters including drug-specific history solved 346/932 (37.1%) cases while 586/932 (62.9%) remained unresolved. Females and younger children carried a lower risk for positive tests (p<0.05, Χ2-test). CONCLUSIONS: Testing with betalactams applying simple, cheap, and safe skin and blood tests can solve a third of DHR-cases on a high throughput scale.