Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:147

Article

Sousa-Pinto, Bernardo^1,2,3  Tarrio, Isabel¹  Blumenthal, Kimberly G.^4,5  Araujo, Luis^2,3  Azevedo, Luis Filipe^1,2  Delgado, Luis^2,3  Fonseca, Joao Almedia^1,2 

[1] Univ Porto, MEDCIDS, Dept Community Med Informat & Hlth Decis Sci, Fac Med, Porto, Portugal

[2] Ctr Hlth Technol & Serv Res, CINTESIS, Rua Dr Placido da Costa, Porto, Portugal

[3] Univ Porto, Basic & Clin Immunol Unit, Dept Pathol, Fac Med, Porto, Portugal

[4] Massachusetts Gen Hosp, Dept Med, Div Rheumatol Allergy & Immunol, Boston, MA 02114 USA

[5] Harvard Med Sch, Boston, MA 02115 USA

关键词: Diagnostic accuracy;    drug provocation test;    IgE quantification;    penicillin allergy;    skin tests;   

DOI  :  10.1016/j.jaci.2020.04.058

来源: Elsevier

【 摘 要 】

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/B-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 (I-2 = 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 (I-2 = 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.

【 授权许可】

Free