Diagnosis of reported beta-lactam hypersensitivity in different diagnostic risk groups

Introduction:
Beta-lactam (BL) antibiotics are one of the most common causes of drug hypersensitivity. Diagnosis of hypersensitivity to BL antibiotics includes: skin prick tests (SPT), intradermal tests (IDT), drug provocation tests (DPT) and allergen-specific IgE (sIgE) determination. Diagnostic methods of BL hypersensitivity remain the same for years.

Aim:
The aim of our study was to analyze the relevance of diagnostic methods in patients with reported BL allergy in different diagnostic risk groups.

Material and methods:
The database included a detailed medical history, laboratory test results and allergy work-up. 263 patients were included in the study. The low-risk group consisted of 88 (33.46%) patients, moderate of 129 (49.05%) patients and 46 (17.49%) patients were classified to the high diagnostic risk group.

Results:
Diagnostic risk groups of hypersensitivity to BL antibiotics do not differ in laboratory results, including a specific IgE level. In 23 (8.7%) patients, hypersensitivity to BL antibiotics was confirmed regardless of the risk group. Among the patients with positive skin tests (10/263, 3.8%) or provocation test (13/263, 4.9%), 6 (2.3%) patients were diagnosed with hypersensitivity to the BL ring, 2 (0.76%) with cross-sensitivity between aminopenicillin, and amino-cephalosporin, 3 (1.14%) were diagnosed with hypersensitivity to two BL antibiotics from different groups, 12 (4.5%) had confirmed hypersensitivity to the reported BL antibiotic, including 6 (2.3%) diagnosed with IgE-independent hypersensitivity to the reported BL antibiotic.

Conclusions:
Diagnostic risk groups of hypersensitivity to BL antibiotics do not differ in laboratory results. Skin tests are useful in diagnosing hypersensitivity to BL antibiotics, but DPT remain the gold standard.