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Table 1 Similarities and differences between Americans and Europeans in the management of β-lactam antibiotic hypersensitivity

From: Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America

  American perspective European perspective Comment
General rules Evaluation mainly by signs and symptoms In history of severe reactionsa: avoidance of allergy tests In history of non-severe reactions: diagnostic approach can be applied Evaluation by clinical history and allergy tests Different
DPTs Recommended if other diagnostic tools are negative Consider contraindications Recommended if other diagnostic tools are negative Consider contraindications Similar
Desensitization Recommended Consider indications and contraindications Recommended Consider indications and contraindications Similar
Immediate reactions
General rules SPTs followed by IDTs are the first to perform Perform DPTs if STs are negative SPTs followed by IDTs are the first to perform Perform DPTs if STs and in vitro tests are negative Similar
STs Penicillins
Recommended: PPL: 5 × 10−5 mol/L MDM: 2 × 10−2 mol/L BP: 10,000 IU/mL Recommended PPL: 5 × 10−5 mol/L MDM: 2 × 10−2 mol/L BP: 10,000 IU/mL Similar
Semisynthetic penicillins
Not routinely recommendeda Recommended AX: 20 mg/mL AMP: 20 mg/mL Different
β-Lactamase inhibitors
Not recommendeda Recommended with original drug and the individual components of the antibiotic combination Different
Cephalosporins
Not recommendeda Recommended with original drug (max: 2–20 mg/mL) Different
Aztreonam/carbapenems
Not recommendeda Recommended Aztreonam: 2 mg/mL; Imipenem/cilastatin: 0.5 mg/mL of each component; Meropenem: 1 mg/mL; Ertapenem: 1 mg/mL Different
Commercially available kits
PRE-PEN® (AllerQuest LLC, Plainville, CT, USA) PPL: 6.0 × 10−5 mol/L DAP® (Diater, Leganés, Madrid, Spain) BP-OL: 0.04 mg/mL (8.64 × 10−5 mol/L) MD: Benzylpenilloate 0.5 mg/mL (1.5 × 10−3 mol/L) AX: 20 mg/mL Different
In vitro tests Serum specific IgE assays
Not recommended Testing with penicillins is recommended Different
Basophil activation tests
Not recommended Recommended as complementary to sIgE Different
Non-immediate reactions
STs/PTs Not recommended PTs followed by delayed-reading IDTs are recommended in routine approach In case of positive PTs, IDTs may be avoided Different
In vitro tests Not recommended Not recommended Similar
Retest
  Repeating penicillin STs routinely is not indicated in patients with a history of non-severe penicillin reactions who have tolerated 1 or more oral penicillin courses Weakly recommended: retesting (2–4 weeks later) patients who suffered severe immediate reactions to BLs and display negative results in the first allergy evaluation, including DPTs  
  1. DPTs drug provocation tests, STs skin tests, SPTs skin prick tests, IDTs intradermal tests, PTs patch tests, PPL benzylpenicilloyl-poly-l-lysine, POL benzylpenicilloyl-octa-l-lysine, MDM minor determinant mixture, MD minor determinant, BP Benzylpenicillin, AX amoxicillin, AMP ampicillin, sIgE specific IgE
  2. aDue to unknown negative predictive values of STs