title: A UK national survey of investigations for beta-lactam hypersensitivity - heterogeneity in practice and a need for national guidelines - on behalf of British Society for Allergy and Clinical Immunology (BSACI).
abstract: BACKGROUND
  Beta lactams (BL) are the most widely prescribed antibiotics in the UK and the commonest cause of hypersensitivity reactions. There are no UK guidelines for BL testing and the most relevant guidelines were devised by the European Network for Drug Allergy (ENDA) on behalf of the European Academy of Allergy and Clinical Immunology.
  
  
  OBJECTIVE
  Delivery of allergy services differs across Europe, so this survey was designed to investigate how closely UK practice adhered to these guidelines.
  
  
  METHODS
  An online survey, using surveymonkey.com software, was sent to all consultants offering an allergy service in the UK and who were members of either BSACI or 'Travellers' (Immunology consultant group).
  
  
  RESULTS
  The response rate was 48% (n=81/165) and BL allergy testing was undertaken by 78% of respondents. All responders requested SsIgE, although four responders stated they rarely requested. Skin testing was undertaken by 87% of respondents who perform beta lactam testing with 17% undertaking skin prick testing (SPT) only, 77% SPT followed by intra-dermal testing (IDT) if the former were negative or indeterminate and 6% SPT and IDT in all cases. The drugs, doses and protocols for skin testing varied considerably. Drug provocation testing was undertaken by 87% of respondents who undertake beta lactam testing with significant heterogeneity in protocols. Respondents that investigated ≤ 20 patients per year demonstrated lower adherence to ENDA recommendations compared to those who saw > 20. Following positive testing, 79% advised avoidance of all penicillins only and the remainder advised additional drug avoidance.
  
  
  CONCLUSIONS
  This survey revealed variation in the investigation and management of BL hypersensitivity in the UK with some centres reporting procedures that could potentially put patients at risk of anaphylaxis if allergy was falsely excluded. This survey highlights an urgent need for evidence based national guidelines and standardisation of practice.
authors.affiliation: School of Immunity and Infection, University of Birmingham, Birmingham, UK. alex.richter@blueyonder.co.uk
authors.forename: A G
authors.initials: AG
authors.lastname: Richter
authors.forename: S M
authors.initials: SM
authors.lastname: Nasser
authors.forename: M T
authors.initials: MT
authors.lastname: Krishna
mesh_terms: D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D017410:Practice Guidelines as Topic; D012882:Skin Tests; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D047090:beta-Lactams / Q000009:adverse effects*
chemical_list: D047090:beta-Lactams; D007073:Immunoglobulin E
keywords: UK; allergy; beta-lactam; cephalosporin; drug provocation test; hypersensitivity; penicillin; serum-specific IgE; skin test; survey