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Challenging dogmas: Intravenous versus oral beta-lactam antibiotic provocation tests.
Molina-Molina, Gustavo-Jorge; Gómez-Duque, Manuel; Vidal Guitart, Xavier; Agustí Escasany, Antònia; Labrador-Horrillo, Moisés; Luengo, Olga; Sala-Cunill, Anna; Galvan-Blasco, Paula; Guilarte, Mar; Cardona, Victoria.
Afiliação
  • Molina-Molina GJ; Allergy Department, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain.
  • Gómez-Duque M; Paediatric Allergy Section, Respiratory Paediatric Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Vidal Guitart X; Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Agustí Escasany A; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Labrador-Horrillo M; Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Luengo O; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Sala-Cunill A; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
  • Galvan-Blasco P; Department of Allergy, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Guilarte M; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
  • Cardona V; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
World Allergy Organ J ; 17(6): 100914, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38855082
ABSTRACT

Background:

Drug provocation tests (DPT) are considered the gold standard procedure to ascertain the diagnosis of beta-lactam (BL) allergy. Regarding route of administration, current recommendations prioritize oral challenges, considering them safer, and reserving the intravenous route for drugs for which this is the only formulation.

Objective:

To compare in terms of tolerance and safety two protocols of BL DPT, using an oral protocol (OR-DPT) and an intravenous protocol (IV-DPT).

Methods:

A descriptive, retrospective study was performed, including adult patients who underwent IV-DPT or OR-DPT for suspected immediate or delayed hypersensitivity to BL antibiotics, over a period of 4 years (between January 2018 and December 2021). Demographical data, index hypersensivity reactions' characteristics and tolerance to DPT were reviewed.

Results:

A total of 1036 patients underwent DPT, mean age of 56.8 (standard deviation, SD, 17.8) years, 655 were women (63.2%). Immediate drug hypersensitivity reactions (DHR) had occurred in 564 of patients (54.4%). OR-DPT were performed in 439 (42.4%) and IV-DPT in 597 (57.6%). The frequency of reactions during DPT, regardless of the route used, was low (3.6%) only 16 (3.6%) in OR-DPT and 21 (3.5%) in IV-DPT. From IV-DPT, 16 out 21 DHR during DPT were immediate compared with 4 out of 16 in OR-DPT. Adjusted relative risk of developing a hypersensitivity reaction during IV-DPT versus OR-DPT was 1.13 (95% confidence interval (CI)0.57-2.22).

Conclusion:

The results suggest that OR-DPT and IV-DPT are both safe procedures when adequately performed. However, IV-DPT protocols showed a higher rate of immediate DHR during DPT probably due to the selection of basal high-risk patients to undergo IV-DPT. In conclusion, IV-DPT may be considered as an option for challenges in drug-allergy studies, entailing a precise administration.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: World Allergy Organ J Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Espanha País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: World Allergy Organ J Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Espanha País de publicação: Estados Unidos