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Oral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity. | LitMetric

Oral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity.

J Allergy Clin Immunol Pract

Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Published: February 2018

AI Article Synopsis

  • The study investigates whether skin tests (ST) are necessary before giving penicillin to patients who previously experienced nonimmediate reactions (NIR) to the drug.* -
  • 710 patients were evaluated, with 96.1% undergoing a penicillin challenge regardless of ST results, leading to very low immediate and late reaction rates.* -
  • The findings conclude that a 5-day oral challenge is safe and effective for determining penicillin tolerance after NIR without needing to perform skin tests beforehand.*

Article Abstract

Background: Penicillins are the drug family most commonly associated with hypersensitivity reactions. Current guidelines recommend negative skin tests (ST) before re-administering penicillins to patients with previous nonimmediate reactions (NIR).

Objective: The objective of this study was to examine whether ST are necessary before re-administering penicillin to patients with NIR.

Methods: Patients with NIR to penicillins starting longer than 1 hour after last dose administration or starting any time after the first treatment day or patients with vague recollection of their reaction underwent penicillin ST. Disregarding ST results, patients were challenged with the relevant penicillins. One-tenth of the therapeutic dose followed by the full dose was administered at 1-hour interval and patients continued taking the full dose for 5 days.

Results: A total of 710 patients with alleged BL allergy were evaluated. Patients with a history of immediate reaction (52, 7.3%) or cephalosporin allergy (16, 2.2%) were excluded. Of the remaining 642 patients, 62.3% had negative ST, 5.3% positive ST, and 32.4% equivocal ST. A total of 617 (96.1%) patients were challenged. Immediate reaction was observed in 9 patients (1.5%): 1-positive ST, 7-negative ST, and 1-equivocal ST (P = .7). Late reaction to the first-day challenge occurred in 24 patients (4%). An at-home challenge was continued by 491 patients. Complete 5-day and partial challenges were well tolerated by 417 (85%) and 44 patients (8.9%), respectively, disregarding ST results. Thirty patients (6.1%) developed mild reactions to the home challenge regardless of their ST results.

Conclusion: A 5-day oral challenge without preceding ST is safe and sufficient to exclude penicillin allergy after NIR developing during penicillin treatment.

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Source
http://dx.doi.org/10.1016/j.jaip.2017.02.023DOI Listing

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