Is a prolonged drug provocation test better than a single-day drug provocation test?: A systematic review and meta-analysis.

beta-lactam hypersensitivity reaction confirming delabeling diagnostic value extended-day single-day drug provocation test systematic review and meta-analysis

Journal

The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220

Informations de publication

Date de publication:
22 Nov 2023
Historique:
received: 09 08 2023
revised: 14 11 2023
accepted: 15 11 2023
medline: 25 11 2023
pubmed: 25 11 2023
entrez: 24 11 2023
Statut: aheadofprint

Résumé

There is currently no standardized duration of drug provocation test (DPT) for confirming/delabeling beta-lactam hypersensitivity reaction (BL-HSR). This meta-analysis and systematic review aimed to investigate the added diagnostic value of extended-day over single-day DPT for confirming/delabeling BL-HSR in adults and children. The MEDLINE, EMBASE, Web of Science, and CINAHL online databases were searched from inception to 15 March 2023 for studies that performed extended-day DPT to confirm/delabel BL-HSR. Risk difference and risk ratio were used to compare the proportions of patients with confirmed BL-HSR by single-day or extended-day DPT. A total of 10,371 DPTs from 42 studies were included. Extended-day DPTs ranged from 2-7 days, or as long as index reactions were reported (maximum 10 days). The overall prevalence of confirmed BL-HSR was 6.96% (3.31% during the first-day DPT, and 3.65% during extended-day DPT). Approximately half of positive reactions during extended-day DPT occurred during the second/third day. The increased detected pool prevalence of confirmed BL-HSR yielded by extended-day DPT was 0.03 (95%CI: 0.02-0.04%; I The increased prevalence of confirmed BL-HSR observed during extended-day DPT could be attributed to the first-day DPT. As a results, our findings do not conclusively support the use of extended-day DPT over single-day DPT. Further studies, incorporating a wash out period, are required to comprehensively compare these two approaches.

Sections du résumé

BACKGROUND BACKGROUND
There is currently no standardized duration of drug provocation test (DPT) for confirming/delabeling beta-lactam hypersensitivity reaction (BL-HSR).
OBJECTIVES OBJECTIVE
This meta-analysis and systematic review aimed to investigate the added diagnostic value of extended-day over single-day DPT for confirming/delabeling BL-HSR in adults and children.
METHODS METHODS
The MEDLINE, EMBASE, Web of Science, and CINAHL online databases were searched from inception to 15 March 2023 for studies that performed extended-day DPT to confirm/delabel BL-HSR. Risk difference and risk ratio were used to compare the proportions of patients with confirmed BL-HSR by single-day or extended-day DPT.
RESULTS RESULTS
A total of 10,371 DPTs from 42 studies were included. Extended-day DPTs ranged from 2-7 days, or as long as index reactions were reported (maximum 10 days). The overall prevalence of confirmed BL-HSR was 6.96% (3.31% during the first-day DPT, and 3.65% during extended-day DPT). Approximately half of positive reactions during extended-day DPT occurred during the second/third day. The increased detected pool prevalence of confirmed BL-HSR yielded by extended-day DPT was 0.03 (95%CI: 0.02-0.04%; I
CONCLUSION CONCLUSIONS
The increased prevalence of confirmed BL-HSR observed during extended-day DPT could be attributed to the first-day DPT. As a results, our findings do not conclusively support the use of extended-day DPT over single-day DPT. Further studies, incorporating a wash out period, are required to comprehensively compare these two approaches.

Identifiants

DOI: 10.1016/j.jaip.2023.11.028 PMID: 38000713
pubmed: 38000713
pii: S2213-2198(23)01297-7
doi: 10.1016/j.jaip.2023.11.028
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023. Published by Elsevier Inc.

Auteurs

Prapasri Kulalert (P)

Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.

Phichayut Phinyo (P)

Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Musculoskeletal Science and Translational Research Center (MSTR), Chiang Mai University, Chiang Mai, Thailand.

Anca Mirela Chiriac (AM)

Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; UMR UA11 Univ Montpellier - INSERM IDESP, Montpellier, France.

Pascal Demoly (P)

Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; UMR UA11 Univ Montpellier - INSERM IDESP, Montpellier, France.

Surasak Saokaew (S)

UNIt of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.

Kantima Kanchanaphoomi (K)

Division of Allergy and Clinical Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Witchaya Srisuwatchari (W)

Division of Allergy and Clinical Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: witchaya.sr@gmail.com.

Classifications MeSH