National Skin Centre, Singapore, Singapore.
Immun Inflamm Dis. 2020 Sep;8(3):371-379. doi: 10.1002/iid3.318. Epub 2020 Jun 7.
β-Lactam allergy is over-reported and this leads to greater healthcare costs. Allergy testing has inherent risks, yet patients who test negative may continue avoiding β-lactams.
To evaluate the safety and diagnostic value of β-lactams allergy testing locally and usage of antibiotics following negative testing.
We performed a retrospective medical record review and follow-up survey of patients who underwent β-lactam testing between 2010 and 2016 at the National Skin Centre, Singapore.
We reviewed the records of 166 patients, with a total of 173 β-lactam allergy labels. Eighty (46.2%) labels were to penicillin, 75 (43.1%) to amoxicillin/amoxicillin-clavulanic acid, 11 (6.4%) to cephalexin, and 5 (2.9%) to others. Skin tests were performed in 142 patients and drug provocation tests (DPTs) in 141 patients. Eleven (6.6%) patients defaulted DPTs after skin testing. Out of 166 patients, 22 (13.3%) patients were proven allergic by either skin tests (16) or DPTs (6). Patients who tested positive had nonsevere reactions. Out of 155 patients who were conclusively evaluated, 133 (85.8%) were not allergic. Of these patients, 30 (22.6%) used the tested β-lactam subsequently, with one reporting a mild reaction. Fifty-one (38.3%) patients were uncontactable or uncertain if they consumed a β-lactam since testing negative. Fifty-two (39.1%) patients had no re-exposure (35 had no indication, 17 were fearful of reactions).
Drug allergy testing was safe and removed inappropriate labels.
Allergy testing is efficacious, but fears of subsequent rechallenge should be addressed to maximize the effectiveness of allergy delabeling.
β-内酰胺类药物过敏被过度报告，这导致了更高的医疗保健费用。过敏测试存在固有风险，但测试结果为阴性的患者可能会继续避免使用β-内酰胺类药物。
评估局部β-内酰胺类药物过敏测试的安全性和诊断价值，以及在测试结果为阴性后抗生素的使用情况。
我们对 2010 年至 2016 年期间在新加坡国家皮肤中心接受β-内酰胺类药物测试的患者进行了回顾性病历审查和随访调查。
我们共审查了 166 名患者的记录，共有 173 个β-内酰胺类药物过敏标签。80 个（46.2%）标签是青霉素，75 个（43.1%）是阿莫西林/克拉维酸，11 个（6.4%）是头孢氨苄，5 个（2.9%）是其他药物。对 142 名患者进行了皮肤测试，对 141 名患者进行了药物激发试验（DPT）。在皮肤测试后，有 11 名（6.6%）患者未能进行 DPT。在 166 名患者中，有 22 名（13.3%）患者通过皮肤测试（16 名）或 DPT（6 名）被证实过敏。阳性测试患者的反应不严重。在 155 名得到明确评估的患者中，有 133 名（85.8%）未过敏。在这些患者中，有 30 名（22.6%）随后使用了测试的β-内酰胺类药物，其中 1 名报告了轻度反应。51 名（38.3%）患者无法联系或不确定他们在测试阴性后是否使用了β-内酰胺类药物。52 名（39.1%）患者未再次接触（35 名没有指征，17 名害怕反应）。
药物过敏测试是安全的，并消除了不适当的标签。
过敏测试是有效的，但应解决对后续再挑战的恐惧，以最大限度地提高过敏去标签的效果。
