Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis - 09/01/21
, Isabel Tarrio, MD a, ∗, Kimberly G. Blumenthal, MD d, e, Luís Araújo, MD b, c, Luís Filipe Azevedo, PhD a, b, Luís Delgado, PhD b, c, João Almeida Fonseca, PhD a, bAbstract |
Background |
Having a penicillin allergy label associates with a higher risk for antibiotic resistance and increased health care use.
Objective |
We sought to assess the accuracy of skin tests and specific IgE quantification in the diagnostic evaluation of patients reporting a penicillin/β-lactam allergy.
Methods |
We performed a systematic review and diagnostic accuracy meta-analysis, searching on MEDLINE, Scopus, and Web of Science. We included studies conducted in patients reporting a penicillin allergy and in whom skin tests and/or specific IgE quantification were performed and compared with drug challenge results. We quantitatively assessed the accuracy of diagnostic tests with bivariate random-effects meta-analyses. Meta-regression and subgroup analyses were performed to explore causes of heterogeneity. Studies’ quality was evaluated using QUADAS-2 criteria.
Results |
We included 105 primary studies, assessing 31,761 participants. Twenty-seven studies were assessed by bivariate meta-analysis. Skin tests had a summary sensitivity of 30.7% (95% CI, 18.9%-45.9%) and a specificity of 96.8% (95% CI, 94.2%-98.3%), with a partial area under the summary receiver-operating characteristic curve of 0.686 (I2 = 38.2%). Similar results were observed for subanalyses restricted to patients reporting nonimmediate maculopapular exanthema or urticaria/angioedema. Specific IgE had a summary sensitivity of 19.3% (95% CI, 12.0%-29.4%) and a specificity of 97.4% (95% CI, 95.2%-98.6%), with a partial area under the summary receiver-operating characteristic curve of 0.420 (I2 = 8.5%). Projected predictive values mainly reflect the low frequency of true penicillin allergy.
Conclusions |
Skin tests and specific IgE quantification appear to have low sensitivity and high specificity. Because current evidence is insufficient for assessing the role of these tests in stratifying patients for delabeling, we identified key requirements needed for future studies.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Diagnostic accuracy, drug provocation test, IgE quantification, penicillin allergy, skin tests
Abbreviations used : AUC-sROC, DPT, NPV, PPV, sIgE
Plan
| This work was supported by the Portuguese Ministry for Science, Technology and Higher Education (Ministério da Ciência, Tecnologia e Ensino Superior), through the Portuguese Foundation for Science and Technology (Fundação para a Ciência e a Tecnologia; grant no. PD/BD/129836/2017). K.G.B. receives career development support from the National Institutes of Health (grant no. NIH K01AI125631), the American Academy of Audiology, Asthma & Immunology Foundation, and the Massachusetts General Hospital (MGH) Claflin Distinguished Scholar Award. |
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| Disclosure of potential conflict of interest: K. G. Blumenthal has a clinical decision support tool for inpatient beta-lactam allergy evaluation used at Partners HealthCare Systems and licensed to Persistent Systems, and receives career development support from the National Institutes of Health (grant no. NIH K01AI125631), the American Academy of Allergy, Asthma, & Immunology (AAAAI) Foundation, and the Massachusetts General Hospital (MGH) Claflin Distinguished Scholar Award. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health, the AAAAI Foundation, or the MGH. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 147 - N° 1
P. 296-308 - janvier 2021 Retour au numéro
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