Assessment of drug hypersensitivity with non-irritating concentrations of antibacterial agents for allergic skin tests: a review
Keywords:Hypersensitivity, Skin prick test, Intradermal tests, Antibacterials, Non-irritating concentration
Hypersensitivity reactions to antibiotics are common with a prevalence of 6-10% of all adverse reactions. There is a lack of guidelines and standardization of skin tests for the screening of hypersensitivity to all antibiotics, in terms of the methodology, dose and time of evaluation of the tests. Literature from Europe and America suggests the use of non-irritating concentration (NIC) of antibiotics for skin testing such as intra dermal test (IDT), skin prick test (SPT). These are concentrations at which the drug is unlikely to produce irritation by virtue of its chemical nature resulting in false positive reactions. These concentrations have been validated by trials in their populations. Due to the increase of antibiotic resistance in our country, declaring a patient allergic to a specific class of antibiotics based on positive skin tests can further narrow the therapeutic armory. These individuals have an increased incidence of infections with resistant organisms as well as increased cost of hospitalization. This is due to the use of alternative broad spectrum antibiotics. Therefore, there is a need for a standardized protocol for the use of skin tests in screening of hypersensitivity, with validated NIC of all antibacterial agents. The aim of this article is to review literature of protocols for assessment of drug hypersensitivity with NIC of antibacterial drugs for SPT, IDT and also establish the need for research in this area in our country.
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255-9.
Romano A, Caubet JC. Antibiotic allergies in children and adults: from clinical symptoms to skin testing diagnosis. J Allergy Clin Immunol Pract. 2014;2(1):3-12.
Green RJ. Antibiotic allergy in the intensive care unit. Curr Allergy Clin Immunol. 2007;20(3):130-5.
Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002;57(1):45-51.
Bukantz SC, Lockey RF, Bousquet J. Allergens and Allergen Immunotherapy. 2nd Edition. Boca Rotan, FL: CRC Press; 1998.
Empedrad R, Darter AL, Earl HS, Gruchalla RS. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol. 2003;112(3):629-30.
Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs – an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702-12.
Solensky R, Khan D, Bernstien IL, Bloomberg GR, Castells MC. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259-73.
Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol. 2014;133(3):790-6.
MacLaughlin EJ, Saseen JJ, Malone DC. Costs of beta-lactam allergies: selection and costs of antibiotics for patients with a reported beta-lactam allergy. Arch Fam Med. 2000;9(8):722-6.
Sánchez-Borges M, Thong B, Blanca M, Ensina LF, González-Díaz S, Greenberger PA, et al. Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy. World Allergy Organ J. 2013;6(1):18.
Romano A, Viola M, Guéant-Rodriguez RM, Gaeta F, Valluzzi R, Guéant JL. Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins. Ann Intern Med. 2007;146(4):266-9.
Nugent JS, Quinn JM, McGrath CM, Hrncir DE, Boleman WT, Freeman TM. Determination of the incidence of sensitization after penicillin skin testing. Ann Allergy Asthma Immunol. 2003;90(4):398-403.
Lee SH, Park HW, Kim SH, Chang YS, Kim SS, Cho SH, et al. The current practice of skin testing for antibiotics in Korean hospitals. Korean J Intern Med. 2010;25(2):207-12.
Abdulazeez S, Al Tajir GK, Sulieman H. Assessment of the current practice of antibiotic skin testing in a tertiary hospital in United Arab Emirates. J Infect Dev. Ctries 2011;5(11):759-64.
Kumar P, Girdhar KK, Anand R, Khera G. Life claiming anaphylaxis to intravenous ceftriaxone after negative skin test. Indian Anesth Forum. 2005; 2-7.
Samanta S, Samanta S, Jha A. Amikacin-triggered anaphylaxis: should we go for skin test? J Pharmacol Pharmacother. 2014;5(1):53-4.
Bhagwat AG, Saxena KN. Intraoperative anaphylaxis to inj ceftriaxone: here we go again. Indian J Anaesth. 2008;52(4):462-6.
Kim SH, Ye YM, Palikhe NS, Kim JE, Park HS. Genetic and ethnic risk factors associated with drug hypersensitivity. Curr Opin Allergy Clin Immunol. 2010;10(4):280-90.
Guéant JL, Guéant-Rodriguez RM, Gastin IA, Cornejo-García JA, Viola M, Barbaud A, et al. Pharmacogenetic determinants of immediate and delayed reactions of drug hypersensitivity. Curr Pharm Des. 2008;14(27):2770-7.