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Inicio Allergologia et Immunopathologia Short and extended provocation tests have similar negative predictive value in n...
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Vol. 47. Issue 5.
Pages 477-483 (September - October 2019)
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Vol. 47. Issue 5.
Pages 477-483 (September - October 2019)
Original Article
DOI: 10.1016/j.aller.2019.01.004
Short and extended provocation tests have similar negative predictive value in non-immediate hypersensitivity to beta-lactams in children
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F.S. Regateiroa,b, I. Rezendec, N. Pintod, C. Abreuc, P. Carreiro-Martinsd,e, E.R. Gomesc,
Corresponding author
evamariasrg@gmx.com

Corresponding author.
a Serviço de Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
b Instituto de Imunologia, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
c Serviço de Imunoalergologia, Centro Hospitalar do Porto, Porto, Portugal
d Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
e Nova Medical School, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisbon, Portugal
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Tables (3)
Table 1. Short vs. extended DPT sample characteristics.
Table 2. Negative predictive value of the DPT and antibiotic refusal after negative DPT.
Table 3. Summary of current study and previously reported findings.
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Abstract
Introduction and objectives

Drug provocation tests (DPTs) are the gold-standard method to diagnose non-immediate hypersensitivity reactions (NIHSR) to beta-lactam antibiotics (BL) in children. Our aim was to compare the negative predictive value (NPV) of one-day (short) DPT versus 3–7 days (extended) DPT for the diagnosis of NIHSR to BL in paediatric age. A secondary aim was to compare confidence on drug re-exposure after short and extended negative DPTs.

Methods

The occurrence of HSR on drug re-exposure and drug refusal after negative diagnostic DPTs were evaluated in children/adolescents with a history of NIHSR to BL using a questionnaire performed six months to ten years after DPT. Patients were divided into two groups according to the protocol performed: short DPT vs. extended DPT.

Results

We enrolled 212 children and adolescents (86 females, 126 males, mean age at DPT 5.52 years, p25=3 years, p75=7.25 years): 69 tested with short DPT, and 143 with extended DPT. The NPV of both types of DPT together was 95.2%. The NPV of short DPT was 97.5% and the NPV of extended DPT was 93.8% (p=0.419). After negative DPT, beta-lactams were refused by carers in 14.75% of the children requiring subsequent treatment, 6.98% in the short DPT group and 18.99% in the extended DPT group (p=0.074).

Conclusions

In our paediatric sample, prolonging drug administration did not increase the NPV of diagnostic DPT for NIHSR to BL or reduce drug refusal. Altogether, the data here reported suggest that, however intuitive, prolonging DPT is not beneficial in the parameters analysed.

Keywords:
Beta-lactams
Children
Drug provocation test
Duration of drug provocation
Negative predictive value
Non-immediate hypersensitivity
Abbreviations:
NIHSR
BL
Amox/clav
DPT
HSR
NPV
CHP
HDE

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