A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with beta‐lactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost‐effective, as possible. For this purpose, a bibliographic search on large studies regarding BL hypersensitivity diagnosis was performed by an EAACI task force, which reviewed and evaluated the literature data using the GRADE system for quality of evidence and strength of recommendation. The updated guidelines provide a risk stratification in BL hypersensitivity according to index reaction(s), as well as an algorithmic approach, based on cross‐reactivity studies, in patients with a suspicion of BL hypersensitivity and an immediate need for antibiotic therapy, when referral to an allergist is not feasible. Furthermore, the update addresses availability and concentrations of skin test (ST) reagents, ST and drug provocation test (DPT) protocols, and diagnostic algorithms and administration of alternative BL in allergic subjects. Specifically, distinct diagnostic algorithms are suggested depending on risk stratification of the patient into high and low risk based on the morphology and chronology of the reaction, immediate (ie, occurring within 1‐6 hours after the last administered dose) or nonimmediate (ie, occurring more than 1 hour after the initial drug administration), and the reaction severity. Regarding the allergy workup, the main novelty of this document is the fact that in some low‐risk nonimmediate reactions ST are not mandatory, especially in children. For DPT, further studies are necessary to provide data supporting the standardization of protocols, especially of those regarding nonimmediate reactions, for which there is currently no consensus.

中文翻译：

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更准确地诊断对β-内酰胺类的超敏反应——EAACI 立场文件

最近对欧洲过敏和临床免疫学学会 (EAACI) 药物过敏兴趣小组 (DAIG) 进行的一项关于欧洲过敏专家如何处理 β-内酰胺 (BL) 超敏反应的调查表明，当前的实践存在显着的异质性，这表明需要审查和更新现有的 EAACI 指南，以使诊断程序尽可能安全、准确，但也尽可能具有成本效益。为此，EAACI 工作组对有关 BL 超敏反应诊断的大型研究进行了书目搜索，该工作组使用 GRADE 系统审查和评估了文献数据，以获取证据质量和推荐强度。更新后的指南根据指标反应以及算法方法提供了 BL 超敏反应的风险分层，根据交叉反应性研究，在怀疑 BL 超敏反应和立即需要抗生素治疗的患者中，当转诊给过敏症专科医生不可行时。此外，更新还涉及皮肤试验 (ST) 试剂、ST 和药物激发试验 (DPT) 协议的可用性和浓度，以及过敏受试者中替代 BL 的诊断算法和管理。具体来说，根据反应的形态和时间顺序，根据患者的风险分层，建议不同的诊断算法，即刻（即，在最后一次给药后 1-6 小时内发生）或非即刻（即，首次给药后 1 小时以上发生），以及反应的严重程度。关于过敏检查，本文件的主要新颖之处在于，在一些低风险的非即时反应中，ST 不是强制性的，尤其是在儿童中。对于 DPT，需要进一步研究以提供支持方案标准化的数据，尤其是关于非即时反应的方案，目前尚未达成共识。