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. 2021 Jan 22;14(2):100506.
doi: 10.1016/j.waojou.2020.100506. eCollection 2021 Feb.

Clinical history in suspected cases of immediate allergy to beta-lactam

Yossi Rosman  1   2 , Mohamad Elmalak  2 , Keren Meir-Shafrir  1 , Idit Lachover-Roth  1   2 , Anat Cohen-Engler  1   2 , Ronit Confino-Cohen  1   2
Affiliations

Clinical history in suspected cases of immediate allergy to beta-lactam

Yossi Rosman et al. World Allergy Organ J. .

Abstract

Background: Mislabeling patients as allergic to beta lactams poses an increased risk of morbidity, healthcare costs, and even mortality. This study aimed to define the accuracy of medical history, taken by a specialist, in diagnosing immediate reaction to beta lactams.

Methods: All patients labeled as allergic to beta lactam were interviewed by a specialist in allergy and clinical immunology and defined as suspected of having a history of immediate or non-immediate reaction. When indicated, skin tests to major and minor determinants and oral graded challenge to the culprit drug were performed.

Results: A total of 909 patients were evaluated. A total of 798 (87.7%) were labeled as allergic to penicillin. In 108 (11.9%) cases, the allergist suspected an immediate reaction based on clinical history. Skin test or challenge proven diagnosis of IgE-mediated allergy to beta lactam were significantly more prevalent in the group with an allergist's suspicion of an immediate allergy (23.1% vs. 5%, p < 0.01). The sensitivity and negative predictive values of an anamnesis of immediate reaction were high (0.9 and 0.95, respectively), but the specificity and positive predictive value were low (0.37 and 0.23, respectively).

Conclusion: Medical history taken by an allergist can exclude immediate hypersensitivity reaction, but it is not specific enough to confirm the diagnosis. Skin testing and graded challenge in suspected cases of immediate hypersensitivity reaction are indicated.

Keywords: Beta lactam allergy; Clinical history; IgE mediated allergy; Immediate allergy; Penicillin allergy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Study design
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