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Determining the negative predictive value of provocation tests with beta‐lactams
Author(s) -
Demoly P.,
Romano A.,
Botelho C.,
BousquetRouanet L.,
Gaeta F.,
Silva R.,
Rumi G.,
Rodrigues Cernadas J.,
Bousquet P. J.
Publication year - 2010
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/j.1398-9995.2009.02228.x
Subject(s) - provocation test , beta lactam , predictive value , beta (programming language) , medicine , value (mathematics) , immunology , mathematics , microbiology and biotechnology , statistics , biology , antibiotics , computer science , pathology , alternative medicine , programming language
To cite this article: Demoly P, Romano A, Botelho C, Bousquet‐Rouanet L, Gaeta F, Silva R, Rumi G, Rodrigues Cernadas J, Bousquet PJ. Determining the negative predictive value of provocation tests with beta‐lactams. Allergy 2010; 65 : 327–332. Abstract Background: The beta‐lactam allergic work‐up is mostly standardized. However, the negative predictive value of drug provocation tests is not yet well established. Method: A historical‐prospective multicentre cohort study was conducted in four centres (one in France, one in Portugal, two in Italy) to assess the negative predictive value of provocation tests with beta‐lactams in patients initially tested for a suspicion of drug allergy/hypersensitivity. Patients were contacted at least 6 months after the work‐up, between 2003 and 2007. A new allergic work‐up was proposed to reacting patients. Results: Among the 457 patients included, 365 (79.9%) were followed up (159 [79.1%] from France, 153 [82.7%] from Italy and 53 [74.6%] from Portugal). Only 118 (25.8%) were re‐exposed to the negatively tested beta‐lactam. Nine (7.6%) reported a non‐immediate (occurring more than 1 h after drug administration) reaction: five urticaria, three exanthema and one undefined cutaneous reaction. None were severe. Only four accepted a re‐challenge, negative in two cases and positive in the two others. The negative predictive value was 94.1% (89.8–98.3) (111 out of 118 patients). Conclusion: Although the negative predictive value of drug provocation tests may not be 100%, none of the false negative patients experienced a life‐threatening reaction. This should reassure doctors who might hesitate to prescribe beta‐lactams, even in patients with negative allergic work‐ups.