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Designing Predictive Models for Beta-Lactam Allergy Using the Drug Allergy and Hypersensitivity Database. | LitMetric

Designing Predictive Models for Beta-Lactam Allergy Using the Drug Allergy and Hypersensitivity Database.

J Allergy Clin Immunol Pract

Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; UPMC Univ Paris 06, Sorbonne Universités, Paris, France.

Published: October 2019

AI Article Synopsis

  • Beta-lactam antibiotics are a common cause of drug allergies, diagnosed mainly through skin tests and drug provocation tests, which can be complicated.
  • The study aimed to create predictive models for diagnosing beta-lactam allergy based on patients' clinical histories, using both retrospective and prospective data from multiple allergy centers.
  • Results showed that while the models provided some predictive value, neither model was effective enough to replace traditional allergy evaluations for diagnosing beta-lactam allergy.

Article Abstract

Background: Beta-lactam antibiotics represent the main cause of allergic reactions to drugs, inducing both immediate and nonimmediate allergies. The diagnosis is well established, usually based on skin tests and drug provocation tests, but cumbersome.

Objectives: To design predictive models for the diagnosis of beta-lactam allergy, based on the clinical history of patients with suspicions of allergic reactions to beta-lactams.

Methods: The study included a retrospective phase, in which records of patients explored for a suspicion of beta-lactam allergy (in the Allergy Unit of the University Hospital of Montpellier between September 1996 and September 2012) were used to construct predictive models based on a logistic regression and decision tree method; a prospective phase, in which we performed an external validation of the chosen models in patients with suspicion of beta-lactam allergy recruited from 3 allergy centers (Montpellier, Nîmes, Narbonne) between March and November 2013. Data related to clinical history and allergy evaluation results were retrieved and analyzed.

Results: The retrospective and prospective phases included 1991 and 200 patients, respectively, with a different prevalence of confirmed beta-lactam allergy (23.6% vs 31%, P = .02). For the logistic regression method, performances of the models were similar in both samples: sensitivity was 51% (vs 60%), specificity 75% (vs 80%), positive predictive value 40% (vs 57%), and negative predictive value 83% (vs 82%). The decision tree method reached a sensitivity of 29.5% (vs 43.5%), specificity of 96.4% (vs 94.9%), positive predictive value of 71.6% (vs 79.4%), and negative predictive value of 81.6% (vs 81.3%).

Conclusions: Two different independent methods using clinical history predictors were unable to accurately predict beta-lactam allergy and replace a conventional allergy evaluation for suspected beta-lactam allergy.

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Source
http://dx.doi.org/10.1016/j.jaip.2017.04.045DOI Listing

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