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Optimal step doses for drug provocation tests to prove beta-lactam hypersensitivity
A-M Chiriac1,2, T Rerkpattanapipat3, P-J Bousquet1
1Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.
Allergy
|August 30, 2016
Summary
This study analyzed drug provocation tests (DPT) for beta-lactam (BL) allergy, identifying optimal step doses and confirming the safety of a one-day protocol for BL allergy diagnosis.
Area of Science:
- Allergy and Immunology
- Pharmacology
- Clinical Medicine
Background:
- Drug provocation tests (DPT) are crucial for beta-lactam (BL) allergy diagnosis after negative skin tests.
- Current DPT protocols lack standardization, leading to variations in empirical dosing and safety considerations.
Purpose of the Study:
- To determine eliciting dose thresholds during BL DPT to propose optimized step doses.
- To assess the safety and efficacy of a standardized 30-minute incremental, one-day DPT protocol.
Main Methods:
- Retrospective analysis of 182 positive BL DPTs in patients with suspected hypersensitivity reactions.
- Utilized survival analysis to identify reactive dose thresholds.
- Evaluated a one-day incremental protocol for immediate and mild non-immediate reactors.
Main Results:
- Identified eliciting thresholds and suggested DPT steps: 5-15-30-50% of the daily therapeutic dose.
- Confirmed the safety of the one-day protocol for both children and adults.
- Recommended a 2-hour post-dose surveillance and 48-hour extended monitoring.
Conclusions:
- A data-driven approach to DPT protocol design enhances standardization for BL antibiotics.
- The proposed protocol offers a safer and more standardized method for BL allergy workup.
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