scholarly journals Macrolide Allergy in Children and the Negative Predictive Value of Drug Provocation Tests in Mild Index Reactions

2021 ◽  
Vol 19 (2) ◽  
pp. 92-99
Author(s):  
Betül Karaatmaca ◽  
Şule büyük yaytokgil ◽  
İlknur Külhaş Çelik ◽  
Özge Yılmaz Topal ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Skin Tests ◽  
Provocation Tests ◽  
Patient Reported ◽  
Drug Provocation Test ◽  
Work Up ◽  
Drug Provocation Tests

ABSTRACT Objective: Macrolide allergy is rarely reported, and there is limited knowledge of hypersensitivity reactions (HRs) in children. The negative predictive value (NPV) of drug provocation tests (DPTs) for macrolides is unresolved. We aim to evaluate the clinical features of macrolide allergy in children, and determine the NPV of macrolide DPTs. Materials and Methods: Pediatric patients who were referred to our allergy department with a suspicion of macrolide allergy were evaluated by DPTs with or without prior skin tests between 2011 and 2020. Characteristics of the HRs and patients, the results of skin and DPTs were recorded. At least three months after evaluation of the patients with allergy work up, telephone interviews were performed. Patients were asked whether they had reused the suspected macrolide or not. Patients who reported HR during subsequent drug intake were invited for reevaluation. Results: A total of 160 children (161 reactions) (55.6% male) with a suspicion of macrolide allergy were enrolled for the study, and all children had a mild index reaction. The median age was 48 (18-102) months, and the median time between the suspected allergic reaction and allergy work-up was 3 (2-8) months. The most frequently reported suspected agent was clarithromycin, in 151 patients (94.4%). Macrolide allergy was confirmed in 8 (5%) patients. Only one patient reported skin eruptions upon reuse despite a negative DPT and he was invited to be reevaluated. A second DPT was performed resulting in urticarial lesions. The NPV was found to be 97.4% for negative DPT with macrolides. Conclusion: Confirmed macrolide allergy is rare in children, and DPTs are the gold standard to assess suspected macrolide allergy. The NPV of macrolide provocation tests seems to be high in children. Keywords: Children, drug hypersensitivity, drug provocation test, macrolide, negative predictive value

Negative predictive value of drug provocation tests in children

2014 ◽  
Vol 25 (7) ◽  
pp. 685-690 ◽  
Author(s):  
Emine D. Misirlioglu ◽  
Muge Toyran ◽  
Murat Capanoglu ◽  
Aysenur Kaya ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Provocation Tests ◽  
Drug Provocation Tests

The negative predictive value of 5-day drug provocation test in nonimmediate beta-lactam allergy in children

2020 ◽  
Vol 124 (5) ◽  
pp. 494-499 ◽  
Author(s):  
Ilknur Kulhas Celik ◽  
Hakan Guvenir ◽  
Selen Hurmuzlu ◽  
Muge Toyran ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Provocation Test ◽  
Beta Lactam ◽  
Drug Provocation Test

scholarly journals Diagnosing and Managing Patients with Reactions to Radiocontrast Media

2021 ◽  
Vol 8 (3) ◽  
pp. 210-221
Author(s):  
Knut Brockow
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Positive Skin ◽  
Provocation Tests ◽  
Ring Molecules ◽  
Allergic Skin ◽  
Drug Hypersensitivity Reactions ◽  
Drug Provocation Tests

Abstract Purpose of the review Iodinated radio contrast media (RCM) belong to the most common elicitors of drug hypersensitivity reactions (HR). Urticaria or anaphylaxis may occur ≤ 1(−6) hour(s) (immediate HR) and exanthems (non-immediate HR) develop > 6 h after application of RCM. Evidence for an immunologic mechanism of RCM HR against the different RCM benzene ring molecules and the benefit of allergological testing in patients with previous hypersensitivity reactions is progressively increasing. Recent findings Positive skin tests can confirm allergy in patients with previous reactions to RCM and help to select alternative better tolerated RCMs. Severe hypersensitivity reactions are mainly caused by an allergic mechanism, whereas the majority of non-severe reactions appear to be non-allergic. Skin testing is highly recommended to help identify allergic hypersensitivity reactions and to select alternatives. Using structurally different RCM is more effective than premedication for the prevention of future reactions. Drug provocation tests to RCM have been increasingly used, but are not yet standardized among different centers. Summary In patients with previous severe hypersensitivity reactions to RCM, skin testing is recommended. For future RCM-enhanced examinations in patients with previous reactions, structurally different, skin test-negative preparations should be applied. Drug provocation tests do confirm or exclude RCM hypersensitivity or may demonstrate tolerability of alternative RCMs.

Systemic reaction during intradermal skin tests with beta-lactams

2021 ◽  
Vol 14 (3) ◽  
pp. e240050
Author(s):  
Joana Carvalho ◽  
Georgeta Oliveira
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Systemic Reaction ◽  
Skin Tests ◽  
Beta Lactam ◽  
Provocation Tests ◽  
Maculopapular Eruption ◽  
Intradermal Tests ◽  
Amoxicillin Clavulanate ◽  
Immediate Reactions

Beta-lactam (BL) antibiotics are the most frequent cause of drug hypersensitivity in children, inducing both immediate and non-immediate reactions. Here we report a case of a 4-year-old child with a disseminated maculopapular exanthema 7 days after the first dose of amoxicillin–clavulanate, referred to our paediatric allergy department. Skin prick tests were negative. Intradermal tests were performed and, after 10 hours, indurated wheals larger than 10×10 mm with progressive erythema and disseminated maculopapular eruption were developed, related to amoxicillin and amoxicillin–clavulanate. Systemic reactions to BL skin tests are rarely reported and the majority are immediate reactions. This case illustrates a rare example of a non-immediate systemic reaction to intradermal tests, underlying the importance of skin testing before drug provocation tests in cases of moderate to severe non-immediate reactions.

scholarly journals Skin and in vitro tests reduce the need for drug provocation tests in drug hypersensitivity to betalactams

2020 ◽  
Author(s):  
Stefan W hrl ◽  
Christian Ostermayer ◽  
Gabriele Sesztak Greinecker ◽  
Reinhart Jarisch ◽  
Wolfgang Hemmer ◽  
...  
Keyword(s):  
Drug Hypersensitivity ◽  
In Vitro Tests ◽  
Provocation Tests ◽  
Drug Provocation Tests

Low negative predictive value of skin tests in investigating delayed reactions to radio-contrast media

2004 ◽  
Vol 50 (6) ◽  
pp. 359-366 ◽  
Author(s):  
C. Vernassiere ◽  
P. Trechot ◽  
N. Commun ◽  
J.-L. Schmutz ◽  
A. Barbaud
Keyword(s):  
Contrast Media ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Skin Tests ◽  
Delayed Reactions

scholarly journals Determining the negative predictive value of provocation tests with beta-lactams

Allergy ◽  
2010 ◽  
Vol 65 (3) ◽  
pp. 327-332 ◽  
Author(s):  
P. Demoly ◽  
A. Romano ◽  
C. Botelho ◽  
L. Bousquet-Rouanet ◽  
F. Gaeta ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Beta Lactams ◽  
Provocation Tests

scholarly journals ROLE OF HYSTEROSALPINGOGRAPHY IN MANAGEMENT OF FEMALE INFERTILITY AND ITS LAPAROSCOPIC CORRELATION

2019 ◽  
pp. 1-2
Author(s):  
(prof.) Alka Agrawal
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Uterine Cavity ◽  
Fallopian Tubes ◽  
Radiographic Technique ◽  
Invasive Techniques ◽  
Work Up ◽  
Tubal Pathology

BACKGROUND : Infertility nowadays has become a medical as well as social problem.Laboratory findings alone is inconclusive in diagnosing infertility.HSG is the radiographic technique for evaluation of uterine cavity & fallopian tubes..Direct visualization of abdominal and pelvic organs in laparoscopy allows a definite diagnosis where clinical examination & less invasive techniques such as ultrasound & HSG fail to identify the abnormality. AIMS & OBJECTIVES :To determine the role of HSG in the evaluation of infertility & to correlate its findings with laparoscopy. METHODS : 75 infertile females aged between 20-40 years were included. HSG & laparoscopy was performed in all patients & findings were analysed. RESULTS : Sensitivity of HSG was 80 %,specificity was 76 % with positive predictive value 63%, negative predictive value 88 % in detecting tubal pathology. Sensitivity of HSG in detecting uterine pathology was 67%, specificity 73%, positive predictive value 39% and negative predictive value 89%. CONCLUSION : HSG has reasonably good sensitivity & specificity in diagnosing tubal & uerine pathology while laparoscopy has diagnostic as well as therapeutic approach.Hence they are complimentary to each other in infertility work up.

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