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Diagnostic Approximation to Delabeling Beta-Lactam Allergic Patients

  • Drug Allergy (C Mayorga, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Abstract

Purpose of review

Beta-lactam antibiotics constitute first-choice drugs for bacterial infections, although the high rate of hypersensitivity reactions constitutes a worldwide health problem. The public health implications of beta-lactam (BL) allergy are enormous as the self-reported penicillin allergy has been associated with antimicrobial resistance, increased cost to health systems, intensive care admission, and death. Therefore, an accurate and rapid diagnosis is crucial.

Recent findings

The diagnostic work-up is mainly based on the performance of an accurate clinical history, skin tests, drug provocation tests and, in some cases, in vitro tests. In recent years, there has been a growing interest on the role of computerized clinical decision support systems to stratify the risk for performing classical diagnostic work-up and in the design of mathematical diagnostic algorithms based on clinical history predictors that would permit the avoidance of high-risk procedures such as skin and drug provocation tests. A precise diagnosis of BL allergy will allow defining phenotypes and endotypes.

Summary

Nowadays, clinical guidelines that use data from the clinical history are not able to delabel patients, although they can be useful in an urgent situation. True delabeling is still based on the performance of in vivo tests, although differences on the pattern of BL consumption cause differences in the diagnostic approach among different countries.

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Funding

The present study has been supported by Institute of Health “Carlos III” of the Ministry of Economy and Competitiveness (grants cofunded by European Regional Development Fund (ERDF): PI15/01206, PI16/00696 and RETICS ARADYAL RD16/0006/0001, RD16/0006/0019; Andalusian Regional Ministry Health (grant PI-0241-2016)). ID is a recipient of a Juan Rodes fellowship (Carlos III Health Institute JR15/00036). TDF holds a “Ramon y Cajal” research contract from Ministry of Economy and Competitiveness (RYC-2013-13138).

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Authors and Affiliations

  1. Allergy Unit, ARADyAL, Hospital Regional Universitario de Málaga, Malaga, Spain

    Maria J. Torres MD, PhD & I. Doña MD, PhD

  2. Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain

    Maria J. Torres MD, PhD

  3. Allergy Research Group, ARADyAL, Instituto de Investigación Biomédica de Málaga-IBIMA, Pavilion 5, basement, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil, 29009, Malaga, Spain

    Maria J. Torres MD, PhD

  4. Allergy Unit, University Hospital of Salamanca, Salamanca, Spain

    E. Moreno MD, PhD, R. Fernandez-Santamaría BsCm, I. Doña MD, PhD & T. D. Fernandez PhD

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  1. Maria J. Torres MD, PhD
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  2. E. Moreno MD, PhD
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  3. R. Fernandez-Santamaría BsCm
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  4. I. Doña MD, PhD
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  5. T. D. Fernandez PhD
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Correspondence to Maria J. Torres MD, PhD.

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Torres, M.J., Moreno, E., Fernandez-Santamaría, R. et al. Diagnostic Approximation to Delabeling Beta-Lactam Allergic Patients. Curr Treat Options Allergy 6, 56–70 (2019). https://doi.org/10.1007/s40521-019-0202-z

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