Leonard Quok Chean Siew1, Philip Hei Li2, Timothy J Watts3, Iason Thomas4, Kok Loong Ue4, M Rosario Caballero3, Krzysztof Rutkowski3, Stephen J Till4, Prathap Pillai4, Rubaiyat Haque4. 1. Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK. Electronic address: leonard.siew@doctors.org.uk. 2. Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China. 3. Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK. 4. Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK.
Abstract
BACKGROUND: There are marked geographical as well as temporal differences in patient sensitization profiles to β-lactams (BL). OBJECTIVE: To determine the utility of skin test reagents and identify a cohort of patients where skin testing can be safely omitted in a cohort of patients referred to a UK tertiary referral center. METHODS: A retrospective study of the clinical characteristics of 1092 patients referred for BL allergy testing was analyzed using multivariate regression analysis. The effectiveness of skin test reagents was also evaluated. RESULTS: Multivariate logistic regression identified that a history of anaphylaxis (odds ratio [OR] 10.98, P = .001) and the patients' recall of the index drug (apart from ampicillin and meropenem, OR 3.51-12.43, P < .05) were independent predictors of type I BL allergic status and a time of less than 1 year elapsed since index reaction significantly increasing the odds of a patient with a history of anaphylaxis, having a type I BL allergy (OR 38.66, P = .003). An absence of anaphylactic severity, unknown name of the index drug and a reaction occurring more than 1 year before testing, has a negative predictive value (NPV) of 98.4%, which was similar to the NPV of skin testing of 98.9% for type I BL allergy. The NPV of skin testing with benzylpenicillin + amoxicillin ± index BL was similar with (98.9%) or without (98.1%) the use of benzylpenicillin polylysine and minor determinant for type I BL allergy. CONCLUSION: We identified a "low risk" cohort of patients where the history is of similar reliability to skin testing in predicting nonallergic status for BL allergy.
BACKGROUND: There are marked geographical as well as temporal differences in patient sensitization profiles to β-lactams (BL). OBJECTIVE: To determine the utility of skin test reagents and identify a cohort of patients where skin testing can be safely omitted in a cohort of patients referred to a UK tertiary referral center. METHODS: A retrospective study of the clinical characteristics of 1092 patients referred for BL allergy testing was analyzed using multivariate regression analysis. The effectiveness of skin test reagents was also evaluated. RESULTS: Multivariate logistic regression identified that a history of anaphylaxis (odds ratio [OR] 10.98, P = .001) and the patients' recall of the index drug (apart from ampicillin and meropenem, OR 3.51-12.43, P < .05) were independent predictors of type I BL allergic status and a time of less than 1 year elapsed since index reaction significantly increasing the odds of a patient with a history of anaphylaxis, having a type I BL allergy (OR 38.66, P = .003). An absence of anaphylactic severity, unknown name of the index drug and a reaction occurring more than 1 year before testing, has a negative predictive value (NPV) of 98.4%, which was similar to the NPV of skin testing of 98.9% for type I BL allergy. The NPV of skin testing with benzylpenicillin + amoxicillin ± index BL was similar with (98.9%) or without (98.1%) the use of benzylpenicillin polylysine and minor determinant for type I BL allergy. CONCLUSION: We identified a "low risk" cohort of patients where the history is of similar reliability to skin testing in predicting nonallergic status for BL allergy.
Authors: Shirley Chiu Wai Chan; Winnie Wan Yin Yeung; Jane Chi Yan Wong; Ernest Sing Hong Chui; Matthew Shing Him Lee; Ho Yin Chung; Tommy Tsang Cheung; Chak Sing Lau; Philip Hei Li Journal: Diagnostics (Basel) Date: 2020-11-09
Authors: Jane Cy Wong; Elaine Yl Au; Heather Hf Yeung; Chak Sing Lau; Philip Hei Li Journal: Allergy Asthma Immunol Res Date: 2021-03 Impact factor: 5.764
Authors: Jason A Trubiano; Sara Vogrin; Kyra Y L Chua; Jack Bourke; James Yun; Abby Douglas; Cosby A Stone; Roger Yu; Lauren Groenendijk; Natasha E Holmes; Elizabeth J Phillips Journal: JAMA Intern Med Date: 2020-05-01 Impact factor: 44.409
Authors: Bernard Yu-Hor Thong; Michaela Lucas; Hye-Ryun Kang; Yoon-Seok Chang; Philip Hei Li; Min Moon Tang; James Yun; Jie Shen Fok; Byung-Keun Kim; Mizuho Nagao; Iris Rengganis; Yi-Giien Tsai; Wen-Hung Chung; Masao Yamaguchi; Ticha Rerkpattanapipat; Wasu Kamchaisatian; Ting Fan Leung; Ho Joo Yoon; Luo Zhang; Amir Hamzah Abdul Latiff; Takao Fujisawa; Francis Thien; Mariana C Castells; Pascal Demoly; Jiu-Yao Wang; Ruby Pawankar Journal: Asia Pac Allergy Date: 2020-01-30