Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre

Leonard Quok Chean Siew; Philip Hei Li; Timothy J. Watts; Iason Thomas; Kok Loong Ue; M. Rosario Caballero; Krzysztof Rutkowski; Stephen J. Till; Prathap Pillai; Rubaiyat Haque

doi:10.1016/j.jaip.2019.03.015

Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre

Leonard Quok Chean Siew^*, Philip Hei Li, Timothy J. Watts, Iason Thomas, Kok Loong Ue, M. Rosario Caballero, Krzysztof Rutkowski, Stephen J. Till, Prathap Pillai, Rubaiyat Haque

^*Corresponding author for this work

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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.

Original language	English
Pages (from-to)	2173-2181.e1
Journal	Journal of Allergy and Clinical Immunology: In Practice
Volume	7
Issue number	7
Early online date	25 Mar 2019
DOIs	https://doi.org/10.1016/j.jaip.2019.03.015
Publication status	Published - 1 Sept 2019

Keywords

Allergy
Challenge
Hypersensitivity
Intradermal test
Penicillin
Provocation
Skin prick test
β-Lactam

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10.1016/j.jaip.2019.03.015

Identifying Low-Risk_SIEW_Accepted12March2019_GREEN AAMAccepted author manuscript, 2.76 MBLicence: CC BY-NC-ND

Cite this

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title = "Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre",

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.",

keywords = "Allergy, Challenge, Hypersensitivity, Intradermal test, Penicillin, Provocation, Skin prick test, β-Lactam",

author = "Siew, {Leonard Quok Chean} and Li, {Philip Hei} and Watts, {Timothy J.} and Iason Thomas and Ue, {Kok Loong} and Caballero, {M. Rosario} and Krzysztof Rutkowski and Till, {Stephen J.} and Prathap Pillai and Rubaiyat Haque",

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doi = "10.1016/j.jaip.2019.03.015",

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T1 - Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre

AU - Siew, Leonard Quok Chean

AU - Li, Philip Hei

AU - Watts, Timothy J.

AU - Thomas, Iason

AU - Ue, Kok Loong

AU - Caballero, M. Rosario

AU - Rutkowski, Krzysztof

AU - Till, Stephen J.

AU - Pillai, Prathap

AU - Haque, Rubaiyat

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

KW - Allergy

KW - Challenge

KW - Hypersensitivity

KW - Intradermal test

KW - Penicillin

KW - Provocation

KW - Skin prick test

KW - β-Lactam

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AN - SCOPUS:85064312326

SN - 2213-2198

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SP - 2173-2181.e1

JO - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

IS - 7

ER -

Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre

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