Delayed positive skin tests in patients with immediate hypersensitivity reactions to beta-lactams
The allergy workup of a presumed immediate drug hypersensitivity reaction (DHR) is well established for beta-lactams (BLs).1 Patients undergo skin tests (STs) (skin prick test and intradermal test [IDT]), followed by an immediate reading. Generally, this reaction occurs when the immediate reading of...
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Veröffentlicht in: | The journal of allergy and clinical immunology in practice (Cambridge, MA) MA), 2020-07, Vol.8 (7), p.2431-2433 |
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Zusammenfassung: | The allergy workup of a presumed immediate drug hypersensitivity reaction (DHR) is well established for beta-lactams (BLs).1 Patients undergo skin tests (STs) (skin prick test and intradermal test [IDT]), followed by an immediate reading. Generally, this reaction occurs when the immediate reading of the IDT reveals a large wheal-and-flare reaction, as shown for respiratory allergens.3,4 Several mechanisms have been put forward to explain the LPR, involving mediators other than histamine (such as TNF-α, IL-65) that orchestrate the recruitment of a mixed cellular infiltrate,6 a prolonged stimulation of mast cells, and altered expression of adhesion molecules on vascular endothelium at the reaction site.4 Late-onset presumed IgE-mediated reactions (urticaria, anaphylaxis) have been described7 mostly after bee stings. Case Age (y), sex Index reaction Culprit (administration route) Reaction interval Reaction duration Reaction treatment Test interval ST positivity∗ Duration of ST positivity (start-end) Tryptase acute (μg/L) Tryptase baseline (μg/L) Maintenance treatment(s) 1 64, F Anaphylaxis AxC (po) 30 min Short (min- h) CS, adrenaline 4 wk Amp, AxC 4 h to 4 d 9.8 6.2 Infliximab, l-thyroxine 2 26, M Anaphylaxis AxC (IV) 30 min after second dose† Short (min- h) Noradrenaline 6 wk Amp, AxC, Pen G 24 h to 5 d 4.8 |
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ISSN: | 2213-2198 2213-2201 |
DOI: | 10.1016/j.jaip.2020.03.039 |