Background

Evaluation of drug allergy is intricate because of nonstandardized testing and challenge method variability.

Objective

To determine the clinical and epidemiologic characteristics of a large group of patients with suspected drug allergies who underwent 1 or more provocation tests (PT), and to establish whether performing this test in fewer steps is safe and effective.

Methods

A cross-sectional descriptive study was conducted in patients with suspected drug allergies who underwent a provocation test at the allergy service of Fundación Valle del Lili, Cali, Colombia, from January 2011 to August 2017.

Results

A total of 508 patients underwent 615 PTs; the median age was 34.5 years (range, 1-87 years) and 332 were women (65.3%). The most frequently implicated drugs were nonsteroidal anti-inflammatory drugs in 362 patients (58.9%), followed by beta-lactam antibiotics in 170 (27.6%), and non–beta-lactam antibiotics in 21 (3.4%). The most typically described manifestations were cutaneous urticaria in 282 patients (45.8%) and angioedema in 220 (35.7%). Most patients underwent the PT without performing other previous tests, which were done in only 92 patients (18.3%). Skin prick tests and intradermal reaction tests were performed in 81 patients (15%); all results were negative. In 519 patients (84.3%), the PT was performed in 2 steps without a placebo. Of the PTs performed in 2 steps, 492 (94.8%) had negative results. In addition, PT was performed in 195 patients (37.6%) in whom 2 equal doses of the drug was administered; 186 patients (95.4%) had negative results.

Conclusion

Performing an open PT (without previous tests) in 2 steps among patients with low-risk drug reactions is safe. However, every case must be analyzed individually in terms of the risk-benefit ratio.

中文翻译：

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低风险药物超敏反应简化方法的描述性分析

背景

由于未标准化的测试和挑战方法的变异性，药物过敏的评估非常复杂。

目的

确定经过1次或更多次激发试验（PT）的一大批可疑药物过敏患者的临床和流行病学特征，并确定以较少的步骤进行该试验是否安全有效。

方法

从2011年1月至2017年8月，在哥伦比亚卡利基金会基金会（FundaciónValle del Lili）的过敏服务中心接受激发试验的疑似药物过敏患者进行了横断面描述性研究。

结果

总共508例患者接受了615例PT。中位年龄为34.5岁（范围为1-87岁），其中332位为女性（65.3％）。涉及最频繁的药物是362例患者中的非甾体类抗炎药（58.9％），其次是170例中的β-内酰胺类抗生素（27.6％）和21例中的非β-内酰胺类抗生素（3.4％）。最典型描述的表现是282例患者的皮肤荨麻疹（45.8％）和220例患者的血管性水肿（35.7％）。大多数患者接受PT时未进行其他先前的检查，仅92例（18.3％）进行了检查。对81例患者（15％）进行了皮肤点刺试验和皮内反应试验；所有结果均为阴性。在519例患者中（84.3％），PT分两步进行，无安慰剂。在2个步骤中执行的PT中，有492个（94.8％）的结果为阴性。此外，在195例（37.6％）患者中进行了PT，其中给予了2等剂量的药物。186例患者（95.4％）阴性。

结论

在具有低风险药物反应的患者中，分两步进行开放式PT（无先前测试）是安全的。但是，必须根据风险收益率对每种情况进行单独分析。