title: Analysis of profitability in the diagnosis of allergy to beta-lactam antibiotics.
abstract: Drug allergy is the third most common reason for allergy consultations. There is a tendency to call any adverse drug reaction (ADR) allergic, even without confirmatory allergy study.
  
  
  OBJECTIVE
  (1) Evaluate time of resolution allergy to beta-lactam's study in a sample of 100 patients. (2) Analyse cost-effectiveness of current diagnostic study (skin tests, specific IgE and drug provocation test (DPT)). (3) Describe type and frequency of ADRs in adult/paediatric patients. (4) Compare cost of complete study with DPT. (5) Assess the need to restructure current study methodology according to results obtained. The study is part of a strategic plan of the allergy department (2005-2010). Patients with suspected allergy to beta-lactams were included. Procedures performed: medical history, specific IgE, skin tests and DPT. Cost/patient analysis. Cost of protocol analysis for current diagnostic/direct DPT.
  
  
  RESULTS
  100 patients were studied, 52 females/48 males; 43 children/57 adults.
  
  
  METHODS
  89 cutaneous, 4 anaphylaxis, 3 vasovagal reactions, 6 non-specific symptoms and 4 not recalled. Allergy was confirmed in six patients (only one child). Complete-study cost: 149.3 Euros/patient. DPT-study cost: 97.19 Euros/patient (34.9% less). Resolution time 9-13 months, absenteeism 28.04%.
  
  
  CONCLUSIONS
  In the series studied, diagnosis of allergy to beta-lactams was confirmed in 6% of patients (2.3% of paediatric patients). After analysing results and cost of the study we believe that we should propose a specific diagnostic algorithm in those paediatric patients without suspected IgE-mediated ADR, and for those patients direct DPT should be conducted. This will reduce cost/patient (-34.9%), time of resolution and absenteeism.
authors.affiliation: Allergy Service, Althaia, Xarxa Assistencial i Universitària de Manresa, Hospital Sant Joan de Déu, Manresa, Barcelona, Spain. Electronic address: lferre@althaia.cat.
authors.forename: L
authors.initials: L
authors.lastname: Ferré-Ybarz
authors.affiliation: Banc de Sang i Teixits Catalunya Central i Vallès Occidental, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Salinas Argente
authors.affiliation: Allergy Service, Althaia, Xarxa Assistencial i Universitària de Manresa, Hospital Sant Joan de Déu, Manresa, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gómez Galán
authors.affiliation: Allergy Service, Althaia, Xarxa Assistencial i Universitària de Manresa, Hospital Sant Joan de Déu, Manresa, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Duocastella Selvas
authors.affiliation: Allergy Service, Althaia, Xarxa Assistencial i Universitària de Manresa, Hospital Sant Joan de Déu, Manresa, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Nevot Falcó
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007159:Immunologic Tests / Q000379:methods*; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Beta-lactam antibiotics; Cost; Drug allergy; Penicillin diagnosis; Profitability