Reaction Risk to Direct Penicillin Challenges: A Systematic Review and Meta-Analysis.

IF 22.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Kimberly G Blumenthal, Liam R Smith, Jushin Teg S Mann, Ingrid Salciccioli, John J O Accarino, Ruchi J Shah, Fatima I Alvi, António Cardoso-Fernandes, Renato Ferreira-da-Silva, Holger J Schunemann, Bernardo Sousa-Pinto
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引用次数: 0

Abstract

Importance: While direct penicillin challenges might support the expansion of penicillin allergy delabeling efforts, the perceived risk of reactions remains a key barrier.

Objective: To evaluate the frequency of reactions to direct penicillin challenges in individuals with penicillin allergy labels and to identify factors associated with such reactions.

Data sources: Three electronic databases were searched (MEDLINE, Web of Science, and Scopus) from inception to July 19, 2023, for primary studies assessing patients undergoing direct penicillin challenges. Articles were included regardless of publication year, language, status, or definition of allergy risk.

Study selection: Two reviewers independently selected original studies reporting the frequency of immunologically mediated reactions following a direct penicillin challenge in patients reporting a penicillin allergy.

Data extraction and synthesis: Two reviewers independently extracted data and independently assessed the quality of each primary study using a risk-of-bias tool for prevalence studies.

Main outcomes and measures: The primary outcome was the frequency of reactions to direct penicillin challenges as calculated using random-effects bayesian meta-analysis of proportions. Secondary outcomes included risk factors for reactions and the frequency of severe reactions.

Results: A total of 56 primary studies involving 9225 participants were included. Among participants, 438 experienced reactions to direct penicillin challenges without prior testing, corresponding to an overall meta-analytic frequency of 3.5% (95% credible interval [CrI], 2.5%-4.6%). Meta-regression analyses revealed that studies performed in North America had lower rates of reaction to direct challenges (odds ratio [OR], 0.36; 95% CrI, 0.20-0.61), while studies performed in children (OR, 3.37; 95% CrI, 1.98-5.98), in outpatients (OR, 2.19; 95% CrI, 1.08-4.75), and with a graded (OR, 3.24; 95% CrI, 1.50-7.06) or prolonged (OR, 5.45; 95% CrI, 2.38-13.28) challenge had higher rates of reaction. Only 5 severe reactions (3 anaphylaxis, 1 fever with rash, and 1 acute kidney injury) were reported, none of which were fatal.

Conclusions and relevance: This systematic review and meta-analysis found that reactions to direct penicillin challenges are infrequent, with rates comparable to indirect challenges after allergy testing. These findings suggest that direct challenges are safe for incorporation into penicillin allergy evaluation efforts across age groups and clinical settings.

青霉素直接接触的反应风险:系统回顾与元分析》。
重要性:尽管直接青霉素挑战可能会支持青霉素过敏标签的扩大,但认为存在的反应风险仍然是一个关键障碍:评估贴有青霉素过敏标签的个体在接受青霉素直接挑战时发生反应的频率,并确定与此类反应相关的因素:检索了从开始到 2023 年 7 月 19 日的三个电子数据库(MEDLINE、Web of Science 和 Scopus),以寻找评估接受青霉素直接挑战的患者的主要研究。无论文章的出版年份、语言、状态或过敏风险的定义如何,均予以纳入:两名审稿人独立选择了报告青霉素过敏患者接受青霉素直接挑战后发生免疫介导反应频率的原始研究:两名审稿人独立提取数据,并使用偏倚风险工具独立评估每项主要研究的质量:主要结果是使用随机效应贝叶斯比例荟萃分析法计算的青霉素直接挑战反应的频率。次要结果包括反应的风险因素和严重反应的频率:共纳入了 56 项主要研究,涉及 9225 名参与者。在参与者中,有 438 人在未经事先测试的情况下直接接受青霉素挑战后出现了反应,对应的总体荟萃分析频率为 3.5%(95% 可信区间 [CrI],2.5%-4.6%)。元回归分析表明,在北美进行的研究对直接挑战的反应率较低(几率比 [OR],0.36;95% CrI,0.20-0.61),而在儿童中进行的研究(OR,3.37;95% CrI,1.98-5.98)、门诊病人(OR,2.19;95% CrI,1.08-4.75)以及分级(OR,3.24;95% CrI,1.50-7.06)或长时间(OR,5.45;95% CrI,2.38-13.28)挑战的研究的反应率较高。仅报告了 5 例严重反应(3 例过敏性休克、1 例发热伴皮疹和 1 例急性肾损伤),均不致命:本系统综述和荟萃分析发现,青霉素直接挑战反应并不常见,其发生率与过敏试验后的间接挑战反应相当。这些研究结果表明,在不同年龄组和临床环境中,将直接挑战纳入青霉素过敏评估工作是安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Internal Medicine
JAMA Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
43.50
自引率
1.30%
发文量
371
期刊介绍: JAMA Internal Medicine is an international, peer-reviewed journal committed to advancing the field of internal medicine worldwide. With a focus on four core priorities—clinical relevance, clinical practice change, credibility, and effective communication—the journal aims to provide indispensable and trustworthy peer-reviewed evidence. Catering to academics, clinicians, educators, researchers, and trainees across the entire spectrum of internal medicine, including general internal medicine and subspecialties, JAMA Internal Medicine publishes innovative and clinically relevant research. The journal strives to deliver stimulating articles that educate and inform readers with the latest research findings, driving positive change in healthcare systems and patient care delivery. As a member of the JAMA Network, a consortium of peer-reviewed medical publications, JAMA Internal Medicine plays a pivotal role in shaping the discourse and advancing patient care in internal medicine.
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