Challenging dogmas

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...

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Autores: Molina-Molina, Gustavo-Jorge|||0000-0002-3577-8512, Gómez-Duque, Manuel, Vidal Guitart, Xavier|||0000-0001-6705-4298, Agustí Escasany, Antònia, Labrador Horrillo, Moises|||0000-0003-3222-2380, Luengo Sánchez, Olga|||0000-0002-8905-2776, Sala-Cunill, Anna|||0000-0002-2178-1067, Galván Blasco, Paula|||0000-0003-3006-3160, Guilarte, Mar|||0000-0001-7242-9584, Cardona, Victoria|||0000-0003-2197-9767
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:294065
Acceso en línea:https://ddd.uab.cat/record/294065
https://dx.doi.org/urn:doi:10.1016/j.waojou.2024.100914
Access Level:acceso abierto
Palabra clave:Drug provocation test
Beta-lactam
Intravenous drug provocation test
Oral drug provocation test
Drug hypersensitivity reaction
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spelling Challenging dogmasIntravenous versus oral beta-lactam antibiotic provocation testsMolina-Molina, Gustavo-Jorge|||0000-0002-3577-8512Gómez-Duque, ManuelVidal Guitart, Xavier|||0000-0001-6705-4298Agustí Escasany, AntòniaLabrador Horrillo, Moises|||0000-0003-3222-2380Luengo Sánchez, Olga|||0000-0002-8905-2776Sala-Cunill, Anna|||0000-0002-2178-1067Galván Blasco, Paula|||0000-0003-3006-3160Guilarte, Mar|||0000-0001-7242-9584Cardona, Victoria|||0000-0003-2197-9767Drug provocation testBeta-lactamIntravenous drug provocation testOral drug provocation testDrug hypersensitivity reactionDrug 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. 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). 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. 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). 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. 22024-01-0120242024-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/294065https://dx.doi.org/urn:doi:10.1016/j.waojou.2024.100914reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2940652026-06-06T12:50:31Z
dc.title.none.fl_str_mv Challenging dogmas
Intravenous versus oral beta-lactam antibiotic provocation tests
title Challenging dogmas
spellingShingle Challenging dogmas
Molina-Molina, Gustavo-Jorge|||0000-0002-3577-8512
Drug provocation test
Beta-lactam
Intravenous drug provocation test
Oral drug provocation test
Drug hypersensitivity reaction
title_short Challenging dogmas
title_full Challenging dogmas
title_fullStr Challenging dogmas
title_full_unstemmed Challenging dogmas
title_sort Challenging dogmas
dc.creator.none.fl_str_mv Molina-Molina, Gustavo-Jorge|||0000-0002-3577-8512
Gómez-Duque, Manuel
Vidal Guitart, Xavier|||0000-0001-6705-4298
Agustí Escasany, Antònia
Labrador Horrillo, Moises|||0000-0003-3222-2380
Luengo Sánchez, Olga|||0000-0002-8905-2776
Sala-Cunill, Anna|||0000-0002-2178-1067
Galván Blasco, Paula|||0000-0003-3006-3160
Guilarte, Mar|||0000-0001-7242-9584
Cardona, Victoria|||0000-0003-2197-9767
author Molina-Molina, Gustavo-Jorge|||0000-0002-3577-8512
author_facet Molina-Molina, Gustavo-Jorge|||0000-0002-3577-8512
Gómez-Duque, Manuel
Vidal Guitart, Xavier|||0000-0001-6705-4298
Agustí Escasany, Antònia
Labrador Horrillo, Moises|||0000-0003-3222-2380
Luengo Sánchez, Olga|||0000-0002-8905-2776
Sala-Cunill, Anna|||0000-0002-2178-1067
Galván Blasco, Paula|||0000-0003-3006-3160
Guilarte, Mar|||0000-0001-7242-9584
Cardona, Victoria|||0000-0003-2197-9767
author_role author
author2 Gómez-Duque, Manuel
Vidal Guitart, Xavier|||0000-0001-6705-4298
Agustí Escasany, Antònia
Labrador Horrillo, Moises|||0000-0003-3222-2380
Luengo Sánchez, Olga|||0000-0002-8905-2776
Sala-Cunill, Anna|||0000-0002-2178-1067
Galván Blasco, Paula|||0000-0003-3006-3160
Guilarte, Mar|||0000-0001-7242-9584
Cardona, Victoria|||0000-0003-2197-9767
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Drug provocation test
Beta-lactam
Intravenous drug provocation test
Oral drug provocation test
Drug hypersensitivity reaction
topic Drug provocation test
Beta-lactam
Intravenous drug provocation test
Oral drug provocation test
Drug hypersensitivity reaction
description 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. 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). 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. 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). 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.
publishDate 2024
dc.date.none.fl_str_mv 2
2024-01-01
2024
2024-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/294065
https://dx.doi.org/urn:doi:10.1016/j.waojou.2024.100914
url https://ddd.uab.cat/record/294065
https://dx.doi.org/urn:doi:10.1016/j.waojou.2024.100914
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
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dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
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collection Dipòsit Digital de Documents de la UAB
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