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

Autores da FMUP

• Bernardo Manuel De Sousa Pinto

  Autor

• Luís Miguel Vieira De Araújo

  Autor

• Luís Filipe Ribeiro De Azevedo

  Autor

• José Luís Dias Delgado

  Autor

• João De Almeida Lopes Da Fonseca

  Autor

Participantes de fora da FMUP

• Tarrio, I
• Blumenthal, KG

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• Patologia

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

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.

Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Keywords

• Diagnostic accuracy; drug provocation test; IgE quantification; penicillin allergy; skin tests