title: Performance in real life of the European Network on Drug Allergy algorithm in immediate reactions to beta-lactam antibiotics.
abstract: European Network on Drug Allergy (ENDA) has proposed an algorithm for diagnosing immediate beta-lactam (BL) allergy. We evaluated its performance in real life. During 1994-2014, 1779 patients with suspected immediate reactions to BL were evaluated following ENDA's short diagnostic algorithm. Five hundred and nine patients (28.6%) were diagnosed of BL hypersensitivity. Of them, 457 (25.7%) were at first evaluation [403 by skin tests (ST), 12 by positive IgE and 42 by controlled provocation tests (CPT)]. At second evaluation (SE), 52 additional patients (10.2% of allergic patients) were diagnosed, [50 (2.8%) by ST and 2 (0.1%) by CPT]. Time between reaction and study was significantly longer in patients diagnosed at SE (median 5 vs 42 months; IQR 34 vs 170; P < 0.0001). Anaphylaxis was significantly associated with a diagnosis at SE. European Network on Drug Allergy/EAACI protocol was appropriate and safe when evaluating BL immediate reactions. Re-evaluation should be performed, particularly when anaphylaxis and long interval to diagnosis are present.
authors.affiliation: Allergy Service, University Hospital of Salamanca, Spain.|IBSAL (Instituto Biosanitario de Salamanca), Salamanca, Spain.|Department of Biomedical and Diagnostic Sciences, Salamanca Medical School, University of Salamanca, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Moreno
authors.affiliation: Allergy Service, University Hospital of Salamanca, Spain.|IBSAL (Instituto Biosanitario de Salamanca), Salamanca, Spain.|Department of Biomedical and Diagnostic Sciences, Salamanca Medical School, University of Salamanca, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Laffond
authors.affiliation: Allergy Service, University Hospital of Salamanca, Spain.|IBSAL (Instituto Biosanitario de Salamanca), Salamanca, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Muñoz-Bellido
authors.affiliation: Allergy Service, University Hospital of Salamanca, Spain.|IBSAL (Instituto Biosanitario de Salamanca), Salamanca, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Gracia
authors.affiliation: Allergy Service, University Hospital of Salamanca, Spain.|IBSAL (Instituto Biosanitario de Salamanca), Salamanca, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Macías
authors.affiliation: Allergy Service, University Hospital of Salamanca, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Allergy Service, University Hospital of Salamanca, Spain.|IBSAL (Instituto Biosanitario de Salamanca), Salamanca, Spain.|Department of Biomedical and Diagnostic Sciences, Salamanca Medical School, University of Salamanca, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Dávila
mesh_terms: D000328:Adult; D000465:Algorithms; D000707:Anaphylaxis / Q000175:diagnosis / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000066491:Clinical Decision-Making; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012882:Skin Tests; D055815:Young Adult; D047090:beta-Lactams / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D007073:Immunoglobulin E
keywords: algorithm; beta-lactam; diagnosis; hypersensitivity; immediate