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- Publisher Website: 10.1016/j.jaip.2019.03.015
- Scopus: eid_2-s2.0-85064312326
- PMID: 30922992
- WOS: WOS:000484456300012
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Article: Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre
Title | Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre |
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Authors | |
Keywords | Hypersensitivity Allergy Challenge Intradermal test Penicillin Provocation Skin prick test β-Lactam |
Issue Date | 2019 |
Citation | Journal of Allergy and Clinical Immunology: In Practice, 2019, v. 7, n. 7, p. 2173-2181.e1 How to Cite? |
Abstract | © 2019 American Academy of Allergy, Asthma & Immunology 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. |
Persistent Identifier | http://hdl.handle.net/10722/281953 |
ISSN | 2023 Impact Factor: 8.2 2023 SCImago Journal Rankings: 1.698 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Siew, Leonard Quok Chean | - |
dc.contributor.author | Li, Philip Hei | - |
dc.contributor.author | Watts, Timothy J. | - |
dc.contributor.author | Thomas, Iason | - |
dc.contributor.author | Ue, Kok Loong | - |
dc.contributor.author | Caballero, M. Rosario | - |
dc.contributor.author | Rutkowski, Krzysztof | - |
dc.contributor.author | Till, Stephen J. | - |
dc.contributor.author | Pillai, Prathap | - |
dc.contributor.author | Haque, Rubaiyat | - |
dc.date.accessioned | 2020-04-09T09:19:13Z | - |
dc.date.available | 2020-04-09T09:19:13Z | - |
dc.date.issued | 2019 | - |
dc.identifier.citation | Journal of Allergy and Clinical Immunology: In Practice, 2019, v. 7, n. 7, p. 2173-2181.e1 | - |
dc.identifier.issn | 2213-2198 | - |
dc.identifier.uri | http://hdl.handle.net/10722/281953 | - |
dc.description.abstract | © 2019 American Academy of Allergy, Asthma & Immunology 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. | - |
dc.language | eng | - |
dc.relation.ispartof | Journal of Allergy and Clinical Immunology: In Practice | - |
dc.subject | Hypersensitivity | - |
dc.subject | Allergy | - |
dc.subject | Challenge | - |
dc.subject | Intradermal test | - |
dc.subject | Penicillin | - |
dc.subject | Provocation | - |
dc.subject | Skin prick test | - |
dc.subject | β-Lactam | - |
dc.title | Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1016/j.jaip.2019.03.015 | - |
dc.identifier.pmid | 30922992 | - |
dc.identifier.scopus | eid_2-s2.0-85064312326 | - |
dc.identifier.hkuros | 312403 | - |
dc.identifier.volume | 7 | - |
dc.identifier.issue | 7 | - |
dc.identifier.spage | 2173 | - |
dc.identifier.epage | 2181.e1 | - |
dc.identifier.isi | WOS:000484456300012 | - |
dc.identifier.issnl | 2213-2198 | - |