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Interest of the allergy workup in the lifting of the label “allergy to beta-lactams” Volume 42, issue 4, Décembre 2023

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Authors
1 Service de pneumo-allergologie C, Hôpital Abderrahmane Mami Ariana, Tunisie ; Université Tunis El Manar, Faculté de médecine de Tunis, Tunisie
2 Service de chirurgie thoracique, Hôpital Abderrahmane Mami Ariana, Tunisie ; Université Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
3 Laboratoire de recherche « Analyse des effets sur la santé des changements climatiques et environnementaux » LR20SP01, Tunisie
* Correspondance : A. Ben Mansour

Introduction

Confirmed hypersensitivity to beta-lactams remains overestimated. The impact of a diagnosis by excess or by default is major. Our work aims to describe the allergy workup approach to suspicion of hypersensitivity to beta-lactams through a series of patients in the Tunisian population.

Methods

Cross-sectional study focused on a sample of patients presenting hypersensitivity to beta-lactams collected in the allergology “C” department of Mami Ariana Hospital between January 2007 and June 2022.

Results

Ninety-eight patients (37 men, 61 women) with an average age of 37.8 years had a suspected allergy to beta-lactam antibiotics. The most common clinical manifestations included: urticaria (n = 73), angioedema (n = 15), anaphylactic shock (n = 13), dyspnea (n = 34), bronchospasm (n = 9), and digestive signs (n = 47). The route of drug administration was the oral route in 83.3 % of cases. The allergy workup was carried out on average 5.5 months after the last presumed drug reaction. Prick tests at pure recommended concentrations were positive in 17 cases (17.3 %) while IDRs were positive in 14 cases. An allergy to cephalosporins was observed in 6 cases. The drug provocation tests performed in 65 patients with negative skin tests were positive in 10 cases. At the end of the allergy workup, the diagnosis of beta-lactam allergy was confirmed in 41 patients (19.3 %).

Conclusion

Allergy to beta-lactams is not uncommon. Beta-lactam skin tests have good diagnostic and predictive value for true beta-lactam allergy.