Roy Ratzon1, Avner Reshef2, Ori Efrati3, Michal Deutch2, Rinat Forschmidt4, Tali Cukierman-Yaffe5, Ron Kenett6, Mona Iancovici Kidon7. 1. Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. 2. Allergy and Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel. 3. Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel. 4. Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel. 5. Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Endocrinology Institute, Gertner Institute for Epidemiology and Health Policy Research, Endocrinology Institute, Sheba Medical Center, Ramat Gan, Israel. 6. University of Turin, Turin, Italy; Center for Research in Risk Engineering, New York University School of Engineering, New York, New York. 7. Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allergy and Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel; Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel. Electronic address: Mona.Kidon@sheba.health.gov.il.
Abstract
BACKGROUND: Drug provocation tests (DPTs) are the gold standard in the diagnosis of β-lactam hypersensitivity. However, no consensus exists on the need for extended provocation tests, even though the effectiveness of the short DPT is relatively low and there has been an increase in the relative incidence of nonimmediate hypersensitivity reactions. OBJECTIVE: To evaluate the effectiveness of a 7-day (extended) DPT compared with a 1-day-only (short) DPT in the management of hypersensitivity reactions to β-lactam antibiotics. METHODS: Patients referred to the allergy clinic of the Sheba Medical Center for suspected β-lactam hypersensitivity from January 2008 to December 2012 underwent in vivo skin tests and an immediate short DPT with the culprit drug. Unless an immediate reaction was clearly documented, patients were offered a 7-day, extended DPT. Long-term effectiveness, calculated as the subsequent use of the tested antibiotic, and satisfaction levels were assessed with a telephone questionnaire. RESULTS: Of 49 negative DPT results, 26 (53%) were long and 23 (47%) were short. A total of 78% of the patients who underwent the long DPT reported that they used the drug compared with 61% of those who underwent only the short DPT (P = .049). Most patients were very satisfied with the drug allergy evaluation process. CONCLUSIONS: An extended DPT protocol increased the effectiveness of the allergy workup in our center without compromising patient satisfaction and safety, and it should be recommended to patients with a history of nonimmediate reaction to β-lactam.
BACKGROUND: Drug provocation tests (DPTs) are the gold standard in the diagnosis of β-lactam hypersensitivity. However, no consensus exists on the need for extended provocation tests, even though the effectiveness of the short DPT is relatively low and there has been an increase in the relative incidence of nonimmediate hypersensitivity reactions. OBJECTIVE: To evaluate the effectiveness of a 7-day (extended) DPT compared with a 1-day-only (short) DPT in the management of hypersensitivity reactions to β-lactam antibiotics. METHODS:Patients referred to the allergy clinic of the Sheba Medical Center for suspected β-lactam hypersensitivity from January 2008 to December 2012 underwent in vivo skin tests and an immediate short DPT with the culprit drug. Unless an immediate reaction was clearly documented, patients were offered a 7-day, extended DPT. Long-term effectiveness, calculated as the subsequent use of the tested antibiotic, and satisfaction levels were assessed with a telephone questionnaire. RESULTS: Of 49 negative DPT results, 26 (53%) were long and 23 (47%) were short. A total of 78% of the patients who underwent the long DPT reported that they used the drug compared with 61% of those who underwent only the short DPT (P = .049). Most patients were very satisfied with the drug allergy evaluation process. CONCLUSIONS: An extended DPT protocol increased the effectiveness of the allergy workup in our center without compromising patient satisfaction and safety, and it should be recommended to patients with a history of nonimmediate reaction to β-lactam.
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