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Vol. 156, No. 4, 2011
Issue release date: November 2011
Section title: Original Paper
Int Arch Allergy Immunol 2011;156:427–433
(DOI:10.1159/000324461)

Risk Assessment of Immediate Systemic Reactions from Skin Tests with β-Lactam Antibiotics

Antico A.a · Pagani M.a · Compalati E.b · Vescovi P.P.a · Passalacqua G.b
aAllergy Unit, Asola Hospital, Department of Internal Medicine, Azienda Istituti Ospedalieri ‘C. Poma’, Mantova, bAllergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/28/2010
Accepted: 1/17/2011
Published online: 8/10/2011
Issue release date: November 2011

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA

Abstract

Background: Some clinical studies have demonstrated that skin tests for β-lactam antibiotics may cause more adverse reactions than skin tests for common allergens. Objective: To assess the risk of systemic reactions from penicillin skin testing, based on a pre-test categorization of patients, in order to establish an appropriate strategy for preempting and dealing with cases. Methods: A case series of 175 patients with a suspected allergy to penicillin was reviewed, and patients were classified as having a low or high probability of allergic sensitization to penicillin, according to their clinical history. For every group, the rate and the increase in the relative risk (RRI) of systemic reactions by skin testing were calculated. The results were compared to those reported in the available literature. Results: In our case series of 175 patients, 52 were classified as having a high probability of being allergic to penicillin, according to their clinical history. Five systemic reactions to skin testing were observed, and these were exclusively in this group (9.61%, RRI = 479). In agreement with the literature, patients with a high likelihood of penicillin allergy showed an increase of up to 10% in the occurrence of systemic reactions at skin testing; in patients who had had severe allergic reactions, this figure was up to 20%. Conclusions: The RRI of systemic reactions by skin testing is proportional to the pre-test probability of a true immediate hypersensitivity reaction to β-lactam antibiotics. In the present case series, only patients with high pre-test probability were at risk, and this group should therefore be skin tested and monitored in a hospitalization regimen, where resuscitation staff and access to an emergency room are immediately available.

© 2011 S. Karger AG, Basel


  

Author Contacts

Correspondence to: Dr. Andrea Antico
Servizio di Allergologia, Presidio Ospedaliero di Asola
Piazza 80° Fanteria 1
IT–46041 Asola (Italy)
Tel. +39 0376 721 238, E-Mail andrea.antico@aopoma.it

  

Article Information

Received: May 28, 2010
Accepted after revision: January 17, 2011
Published online: August 10, 2011
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 3, Number of References : 35

  

Publication Details

International Archives of Allergy and Immunology

Vol. 156, No. 4, Year 2011 (Cover Date: November 2011)

Journal Editor: Valenta R. (Vienna)
ISSN: 1018-2438 (Print), eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/28/2010
Accepted: 1/17/2011
Published online: 8/10/2011
Issue release date: November 2011

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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