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Short and extended provocation tests have similar negative predictive value in non-immediate hypersensitivity to

F S Regateiro1, I Rezende2, N Pinto3

  • 1Serviço de Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Instituto de Imunologia, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.

Allergologia Et Immunopathologia
|March 27, 2019
PubMed

Insights

Extending drug provocation tests (DPTs) for non-immediate hypersensitivity reactions to beta-lactam antibiotics in children does not improve diagnostic accuracy or reduce drug refusal. Shorter DPTs are as effective as extended ones for diagnosing these reactions.

Area of Science:

  • Pediatric Allergy and Immunology
  • Clinical Pharmacology
  • Drug Hypersensitivity

Background:

  • Drug provocation tests (DPTs) are the gold standard for diagnosing non-immediate hypersensitivity reactions (NIHSR) to beta-lactam (BL) antibiotics in children.
  • The duration of DPTs, whether short (one-day) or extended (3-7 days), is a key consideration in clinical practice.

Purpose of the Study:

  • To compare the negative predictive value (NPV) of short versus extended DPTs for diagnosing NIHSR to BL in pediatric patients.
  • To evaluate and compare parental confidence in drug re-exposure following negative short and extended DPTs.

Main Methods:

  • A retrospective study evaluated children and adolescents with a history of NIHSR to BL.
  • Patients were categorized into short DPT and extended DPT groups.
  • Outcomes, including hypersensitivity reactions (HSR) and drug refusal, were assessed via questionnaire 6 months to 10 years post-DPT.

Main Results:

  • The overall NPV for DPTs was 95.2%.
  • The NPV for short DPTs was 97.5%, compared to 93.8% for extended DPTs (p=0.419).
  • Drug refusal after a negative DPT occurred in 6.98% of the short DPT group versus 18.99% in the extended DPT group (p=0.074).

Conclusions:

  • Prolonging DPT duration in pediatric patients did not enhance the NPV for diagnosing NIHSR to BL.
  • Extended DPTs did not significantly reduce drug refusal rates compared to short DPTs.
  • The findings suggest that prolonging DPTs offers no discernible benefit for the analyzed parameters.
Abstract

Keywords:
Beta-lactamsChildrenDrug provocation testDuration of drug provocationNegative predictive valueNon-immediate hypersensitivity

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