Journal of Allergy and Clinical Immunology-In Practice最新文献

{"title":"Guidance for the Evaluation by Payors of Claims Submitted Using Current Procedural Terminology Codes 95165, 95115, and 95117.","authors":"J Allen Meadows, Gary N Gross, Anita N Wasan, Dole P Baker, Amber Patterson, Robert Puchalski, Anil Nanda, Jami Lucas, J Wesley Sublett, Paul V Williams","doi":"10.1016/j.jaip.2024.10.025","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.10.025","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Class I HLA Alleles are associated with an increased risk of osimertinib-induced hypersensitivity.","authors":"Chun-Bing Chen, Chuang-Wei Wang, Chun-Wei Lu, Wei-Ti Chen, Bing-Rong Zhou, Chia-Yu Chu, Shang-Fu Hsu, Cheng-Ta Yang, John Wen-Cheng Chang, Chan-Keng Yang, Chih-Liang Wang, Yueh-Fu Fang, Ping-Chih Hsu, Chung-Ching Hua, Chiao-En Wu, How-Wen Ko, Kun-Chieh Chen, Yi-Chien Yang, Han-Chi Tseng, An-Yu Cheng, Li-Chuan Tseng, Feng-Ya Shih, Shuen-Iu Hung, Cheng-Yang Huang, Wen-Hung Chung","doi":"10.1016/j.jaip.2024.10.027","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.10.027","url":null,"abstract":"<p><strong>Background: </strong>Osimertinib, a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), shows superior lung cancer treatment efficacy. However, osimertinib-induced severe hypersensitivity, including Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), is frequently observed in Asian populations and hinders cancer treatment.</p><p><strong>Objective: </strong>We investigated the genetic HLA predisposition and immune pathomechanism of osimertinib-induced hypersensitivity.</p><p><strong>Methods: </strong>We enrolled 17 patients with osimertinib-induced delayed hypersensitivity (7 with severe SJS/TEN and 10 with mild maculopapular exanthema [MPE]), 98 osimertinib-tolerant subjects, and 2123 general population controls. HLA genotyping, drug-induced lymphocyte activation test (LAT), and surface plasmon resonance (SPR) assay were performed.</p><p><strong>Results: </strong>HLA-B*51:02 was present in 83.3% of osimertinib-induced SJS/TEN patients but only in 3.3% of the general population controls (P = 2.8×10^-7, Pc=6.9×10^-6, odds ratio [OR]=146), and 0% of osimertinib-tolerant controls (P = 6.5×10^-8, Pc=1.6×10^-6, OR=707). The association of HLA-B*51:01 and HLA-A*24:02 with osimertinib-induced MPE patients, rather than with osimertinib-tolerant subjects (P = 0.002, OR=15.7 for HLA-B*51:01; P = 0.003, OR=9.5 for HLA-A*24:02), was identified as a phenotype-specific association. Granulysin-the SJS/TEN-specific cytotoxic protein-was significantly higher in SJS/TEN patients' plasma (39.8±4.5 ng/ml, P<0.001) and in in vitro LAT (sensitivity=83.3%, P<0.01) compared to the tolerant controls. Patients with osimertinib-induced hypersensitivity appeared to tolerate alternative EGFR-TKIs. SPR results also confirmed that HLA-B*51:02 protein has a higher binding affinity for osimertinib and lower or no affinity for other EGFR-TKIs.</p><p><strong>Conclusions: </strong>HLA-B*51:02 frequently occurs in Asian populations and is strongly associated with osimertinib-induced SJS/TEN. Our findings suggest HLA-B*51:02 screening as a preemptive test to reduce osimertinib-induced severe hypersensitivity.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bee/Vespula venom-specific IgE ratio ≥5:1 indicates culprit insect in double-sensitized patients.","authors":"Simon Tischler, Axel Trautmann, Matthias Goebeler, Johanna Stoevesandt","doi":"10.1016/j.jaip.2024.10.029","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.10.029","url":null,"abstract":"<p><strong>Background: </strong>Venom-allergic patients are frequently double-sensitized to honeybee venom (BV) and Vespula venom (VV); genuine double allergy is uncommon.</p><p><strong>Objectives: </strong>To assess if quantitative comparison of BV and VV-specific IgE levels permits to identify the culprit venom in double-sensitized patients; to evaluate whether independent sensitization to BV- and VV-specific components corresponds to an indication for double immunotherapy.</p><p><strong>Methods: </strong>This single centre observational study evaluates 1069 consecutive patients; 490 non-allergic controls were available for statistical comparison. The diagnosis (BV allergy, VV allergy, double allergy) based on a comprehensive allergological work-up including patient history, IgE serology, intradermal skin test, and - if required - basophil activation testing. Quantitative allergen-specific IgE to BV, VV, rApi m 1, rVes v 5 was retrospectively compared with the final diagnosis; the ratio of BV/VV-specific IgE levels was considered in double-sensitized venom-allergic patients.</p><p><strong>Results: </strong>Sensitization to whole venom preparations and components was frequent in patients and asymptomatic controls, with higher specific IgE levels in the patient group. An at least 5:1-dominance of the specific IgE to either BV or VV was documented in 239 (52.1 %) of 459 double-sensitized venom-allergic patients; 232 (97.1%) of these patients were diagnosed mono-allergic to only the venom they were dominantly sensitized to.</p><p><strong>Conclusions: </strong>Five:1-dominant specific IgE indicates the culprit venom in double-sensitized allergic patients. Additional component-resolved diagnostic testing can be restricted to cases with double sensitization to whole venoms at a ratio less than 5:1. Double sensitization to rApi m 1 and rVes v 5 per se does not justify double venom immunotherapy.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An International Delphi Consensus on the Management of Pollen-Food-Allergy Syndrome: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee.","authors":"Taha Al-Shaikhly, Amanda Cox, Anna Nowak-Wegrzyn, Antonella Cianferoni, Constance Katelaris, Didier G Ebo, George N Konstantinou, Hannelore Brucker, Hyeon-Jong Yang, Jennifer L P Protudjer, José Laerte Boechat, Joyce E Yu, Julie Wang, Karen S Hsu Blatman, Lukasz Blazowski, Mahesh Padukudru Anand, Manish Ramesh, Maria J Torres, Mark Holbreich, Richard Goodman, Richard L Wasserman, Russell Hopp, Sakura Sato, Isabel Skypala","doi":"10.1016/j.jaip.2024.09.037","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.09.037","url":null,"abstract":"<p><strong>Background: </strong>Pollen-food-allergy syndrome (PFAS) is common among patients with allergic rhinitis. Treatment recommendations for patients with PFAS remain variable.</p><p><strong>Objective: </strong>To develop consensus recommendation statements for managing patients with PFAS.</p><p><strong>Methods: </strong>An international panel of allergists, researchers, and nutritionists with an interest in PFAS from 25 different institutions across 11 countries convened and a list of statements was written by 3 authors. The RAND/University of California Los Angeles methodology was adopted to establish consensus on the statements.</p><p><strong>Results: </strong>After 2 Delphi rounds, a consensus was reached on 14 statements. The panel agreed that patients with PFAS would benefit from counseling on the nature and basis of PFAS and the rare chance of more severe systemic reactions and their recognition. The panel agreed on avoiding the raw food responsible for the index reaction, but not potentially cross-reactive fruits/vegetables based on the responsible food of the index reaction. Epinephrine autoinjectors should be recommended for patients with PFAS who experienced severe symptoms (beyond the oropharynx) or for patients considered at risk for severe reactions. The panel agreed that the benefit of allergen immunotherapy remains unclear and that PFAS should not be considered the primary indication for such intervention.</p><p><strong>Conclusions: </strong>We developed consensus statements regarding counselling patients about the nature and severity of PFAS, potential risk factors, dietary avoidance, epinephrine autoinjector prescription, and allergen immunotherapy consideration for patients with PFAS.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Sex and Gender in Immediate Beta-Lactam Antibiotic Allergy: A Systematic Review and Meta-analysis.","authors":"Nisha B Patel, Gabriel Cojuc-Konigsberg, Danna Garcia-Guaqueta, Divya Shah, Darshana Balasubramaniam, Avanika Mahajan, Fnu Shakuntulla, Danielle Gerberi, Lyda Cuervo-Pardo, Miguel A Park, Thanai Pongdee, Elina Jerschow, Avni Joshi, Zhen Wang, Alexei Gonzalez-Estrada, Sergio E Chiarella","doi":"10.1016/j.jaip.2024.10.031","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.10.031","url":null,"abstract":"<p><strong>Background: </strong>Beta-lactams are the most common antibiotic class reported to cause allergic drug reactions. Previous literature suggests an increased prevalence of penicillin drug allergy in female patients in both inpatient and outpatient settings. However, the effects of sex and gender have not been well characterized regarding the entire class of beta-lactam antibiotics.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to identify sex and gender-based differences in the prevalence of immediate beta-lactam allergy.</p><p><strong>Methods: </strong>We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library between 2013-2023. Patients with a documented beta-lactam allergy who underwent allergy testing with skin testing, oral drug challenge, or serum-specific IgE were included. We quantitatively assessed sex- and gender-based differences in beta-lactam allergy with meta-analysis.</p><p><strong>Results: </strong>We included 69 primary studies, assessing 53,989 participants from outpatient and inpatient cohorts. 7,558 patients had a confirmed beta-lactam allergy. There was no difference in the prevalence of positive beta-lactam allergy test between males and females. Sub-group analysis of studies that performed oral challenges did show a higher risk of beta-lactam allergy in females than males (RR 1.40, 95% CI 1.18-1.66, p < 0.001, I² =77.8%). Finally, there was a higher proportion of females (64.8%) than males enrolled in beta-lactam allergy studies.</p><p><strong>Conclusions: </strong>Our findings suggest both sex-based and gender-based differences in the prevalence of immediate beta-lactam allergy. Both biological factors, such as sex hormones, and gender-based behaviors, including increased healthcare utilization, may contribute to higher rates of beta-lactam allergy diagnosis in females.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AAAAI Position Statement on Changing Electronic Health Record Allergy Documentation to \"Alerts\" to Lead to Easily Understood, Actionable Labels.","authors":"Andrew A White, Allison Ramsey, Autumn Guyer, Ryan B Israelsen, Farah Khan, Blanka Kaplan, Santhosh Kumar, Kimberly G Blumenthal, Kimberly Risma, Sujani Kakumanu, Eric Macy","doi":"10.1016/j.jaip.2024.09.034","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.09.034","url":null,"abstract":"<p><p>The term \"allergy\" is inaccurate for the vast majority of the contents in the current allergy fields of electronic health records (EHRs). While EHRs have transformed access to health information and streamlined the delivery of care, their ability to reliably indicate medications, vaccines, or foods that mandate avoidance versus preferences or mild intolerances, is suboptimal. The current systems are reactive instead of being proactive and frequently fail to communicate the appropriate course of action. This Position Statement of the American Academy of Allergy, Asthma and Immunology (AAAAI) advocates for a change in terminology. The section of the EHR currently labeled \"allergies\" should be renamed \"alerts.\" The term \"alert\" accurately captures the purpose of this section without incorrectly assigning an allergic mechanism, and prioritizes easily understood and actionable labels. This change has the potential to simultaneously improve patient safety and care. This shift will be the first step in the transformation of the alerts section of the EHR. This document provides a framework for categorizing what should be included in this section. Enacting these changes will require EHR and clinical decision support vendors, healthcare and data standard regulators, allergists, and the larger health care community to work together to bring about these important advances.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empiric elimination diets for eosinophilic esophagitis: barriers, facilitators, and impact on quality of life.","authors":"Pooja Mehta, Zhaoxing Pan, Glenn T Furuta, Kara Kliewer","doi":"10.1016/j.jaip.2024.10.030","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.10.030","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allergic Rhinitis and Keratoconus: A Systematic Review and Meta-Analysis.","authors":"Jui-En Lo, Yen-Hsi Huang, Neil Bhattacharyya, Eric Alan Moulton, Kevin Sheng-Kai Ma","doi":"10.1016/j.jaip.2024.05.050","DOIUrl":"10.1016/j.jaip.2024.05.050","url":null,"abstract":"<p><strong>Background: </strong>The relationship between keratoconus and various allergic diseases has been a subject of controversy.</p><p><strong>Objective: </strong>In the present study, a systematic review and meta-analysis was conducted to investigate the association between allergic rhinitis (AR) and keratoconus.</p><p><strong>Methods: </strong>Relevant and eligible studies from PubMed, Web of Science, and the Cochrane Library were systematically reviewed to evaluate the association between AR and keratoconus. Observational studies that reported the number of patients with and without keratoconus, as well as the number of patients with keratoconus diagnosed with or without AR, were included. Two reviewers independently screened eligible studies and extracted data. A bivariate meta-analysis was conducted to calculate the pooled odds ratio of keratoconus in patients with versus without AR. A sensitivity analysis was performed using the adjusted odds ratio reported in the included studies to validate the findings.</p><p><strong>Results: </strong>Seven studies involving 775,574 participants were included in the meta-analysis. Among them, 29,082 patients had keratoconus. The pooled odds ratio of keratoconus in patients with AR was 1.71 (95% confidence interval [CI]: 1.36-2.15; P < .001; I² = 96%), and the pooled adjusted odds ratio was 1.72 (95% CI: 1.23-2.40; P = .001; I² = 97%).</p><p><strong>Conclusions: </strong>Patients with AR have significantly higher odds of keratoconus than those without AR. Future studies are warranted to investigate the causal relationship and evaluate the cost-effectiveness of early screening, using methods such as corneal topography, and referral for keratoconus in patients with AR.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Performance of 4 Penicillin-Allergy Prediction Strategies in a Large Cohort.","authors":"Ileana-Maria Ghiordanescu, Iuliana Ciocănea-Teodorescu, Nicolas Molinari, Anais Jelen, Omar Al-Ali, Rik Schrijvers, Pascal Demoly, Anca Mirela Chiriac","doi":"10.1016/j.jaip.2024.07.012","DOIUrl":"10.1016/j.jaip.2024.07.012","url":null,"abstract":"<p><strong>Background: </strong>A safe and pragmatic guide for labelling and delabelling patients with suspected penicillin allergy is mandatory.</p><p><strong>Objective: </strong>To compare the performance of 4 penicillin-allergy prediction strategies in a large independent cohort.</p><p><strong>Methods: </strong>We conducted a retrospective study for subjects presenting between January 2014 and December 2021 at the University Hospital of Montpellier, with a history of hypersensitivity to penicillins. The outcome targeted by the study was a positive penicillin-allergy test.</p><p><strong>Results: </strong>Of the 1,884 participants included, 382 (20.3%) had positive penicillin-allergy tests. The ENDA (European Network on Drug Allergy) and Blumenthal strategies yielded relatively high sensitivities and low specificities and, by design, did not misclassify any positive subjects with severe index reactions. The PEN-FAST <3 score had a negative predictive value of 90% (95% confidence interval [95% CI] 88%-91%), with a sensitivity of 66% (95% CI 62%-71%) and a specificity of 73% (95% CI 71%-75%), and incorrectly delabelled 18 subjects with anaphylaxis and 15 with other severe nonimmediate reactions. For the adapted Chiriac score, the specificity corresponding to 66% sensitivity was 73% (95% CI 70%-75%). Conversely, at a 73% specificity threshold, the sensitivity was 65% (95% CI, 61%-70%). Attempts to improve these prediction algorithms did not substantially enhance performance.</p><p><strong>Conclusions: </strong>The ENDA and Blumenthal strategies are safe for high-risk subjects, but their delabelling effectiveness is limited, leading to unnecessary avoidance. Conversely, the PEN-FAST and Chiriac scores are performant in delabelling, but more frequently misclassify high-risk subjects with positive penicillin-allergy tests. Selection of the most appropriate tool requires careful consideration of the target population and the desired goal.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Immediate and Delayed Maximal Nonirritating Skin Testing Concentrations of β-Lactam Antibiotics.","authors":"Alexei Gonzalez-Estrada, Ismael Carrillo-Martin, W Tatiana Garzon-Siatoya, Hajara Joundi, Dan Morgenstern-Kaplan, J Ross Renew, H Ross Powers, Jared D Nelson, Wendelyn Bosch, Kevin L Epps, Aurora Gonzalez-Estrada, Susan Kinate, Matthew A Rank, Christine R F Rukasin, Gerald W Volcheck, Miguel Park","doi":"10.1016/j.jaip.2024.07.022","DOIUrl":"10.1016/j.jaip.2024.07.022","url":null,"abstract":"<p><strong>Background: </strong>Maximal skin testing (ST) nonirritant concentrations (NICs) are consistent for penicillin and aminopenicillin among guidelines. However, there is variability among guidelines for maximal ST NICs of cephalosporins.</p><p><strong>Objective: </strong>To determine maximal immediate and delayed ST NICs of 15 β-lactams in β-lactam-tolerant and β-lactam-naïve participants.</p><p><strong>Methods: </strong>We performed a single-center, nonrandomized prospective study between September 2019 and January 2022 in adult participants. Participants received skin prick testing (SPT) and intradermal test (IDT) injections at 6 increasing concentrations of 1 or more β-lactams. A concentration was considered irritant when more than 5% of participants had a positive test. A positive test was defined as a wheal ≥3 mm compared with negative control accompanied by a ≥5 mm flare for SPT/IDT and induration ≥5 mm with associated erythema at 48 hours for delayed readings (dIDT). Sensitivity analyses using 3 alternative IDT positive criteria were conducted.</p><p><strong>Results: </strong>A total of 747 participants with a median age of 64 (interquartile range: 54-72) years (52% male, 85% White, and 92% non-Hispanic) underwent 20,858 skin tests. All undiluted SPT concentrations were nonirritant. We found the following maximal IDT/dIDT NICs (mg/mL): ampicillin (41.6/125), ampicillin-sulbactam (93.8/187.5), aztreonam (6.3/25), cefazolin (55/165), cefepime (35/140), cefoxitin (45/90), ceftaroline (7.5/15), ceftriaxone (58.3/175), cefuroxime (55/110), ertapenem (16.6/50), imipenem-cilastin (6.3/25), meropenem (8.3/25), nafcillin (31.3/62.5), oxacillin (20.9/83.5), and piperacillin-tazobactam (112.5/225). dIDTs were almost all completely nonirritant close to or at undiluted concentrations. There were no differences when we applied 3 IDT positivity criteria to our raw data.</p><p><strong>Conclusions: </strong>Our results suggest that SPTs with undiluted stock β-lactam antibiotic concentrations are nonirritant. Compared with previously published nonirritant concentrations, we propose a 2- to 50-fold increase to the maximal IDT and dIDT NICs of 15 β-lactam antibiotics. When performing dIDTs, a higher concentration should be used rather than the same IDT concentration.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}