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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