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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