@article{SchrueferStoevesandtTrautmann2022,
  author    = {Schr{\"u}fer, Philipp and Stoevesandt, Johanna and Trautmann, Axel},
  title     = {Outcome of a de-labelling algorithm compared with results of penicillin (β-lactam) allergy testing},
  series = {Allergy, Asthma \& Clinical Immunology},
  volume    = {18},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  issn      = {1710-1484},
  doi       = {10.1186/s13223-022-00659-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299840},
  year      = {2022},
  abstract  = {Background Penicillin allergy labels frequently impede guideline-directed treatment with a penicillin or other β-lactam antibiotics. Despite presumed allergy, targeted questioning may indicate a low probability of sensitization and permit reasonably safe administration of the antibiotic in question. In this study, we evaluated a standardized algorithm aiming to differentiate non-allergic patients from those with true allergic β-lactam hypersensitivity. Methods We retrospectively applied a de-labelling algorithm in 800 consecutive patients with suspected β-lactam hypersensitivity. All had undergone complete allergy work-up permitting to definitely exclude or diagnose β-lactam allergy between 2009 and 2019. Results In 595 (74.4\%) out of 800 cases evaluated, β-lactam allergy could be excluded by negative challenge testing. IgE-mediated anaphylaxis was diagnosed in 70 (8.7\%) patients, delayed-type hypersensitivity in 135 (16.9\%). In 62 (88.6\%) anaphylaxis cases, the algorithm correctly advised to use an alternative antibiotic. Accuracy was higher in patients with moderate to severe anaphylaxis (97.7\%) compared to those with a history of mild reactions (73.1\%). The algorithm correctly identified 122 (90.4\%) patients with proven delayed-type hypersensitivity. It permitted de-labelling in 330 (55.5\%) out of 595 patients with diagnostic exclusion of penicillin hypersensitivity, but failed to identify the remaining 265 (44.5\%) as low-risk cases. Conclusions The algorithm detected 89.8\% of cases with penicillin (β-lactam) allergy, sensitivity was optimal for moderate to severe anaphylaxis. Study data justify the implementation of a standardized de-labelling algorithm under close supervision in order to permit guideline-directed treatment and reduce the use of broad-spectrum antibiotics as part of an antibiotic stewardship program.},
  language  = {en}
}
@article{TrautmannBrockowStoevesandt2020,
  author    = {Trautmann, Axel and Brockow, Knut and Stoevesandt, Johanna},
  title     = {Metamizole-induced reactions as a paradigm of drug hypersensitivity: Non-allergic reactions, anaphylaxis, and delayed-type allergy},
  series = {Clinical \& Experimental Allergy},
  volume    = {50},
  journal   = {Clinical \& Experimental Allergy},
  number    = {9},
  doi       = {10.1111/cea.13689},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-217997},
  pages     = {1103 -- 1106},
  year      = {2020},
  language  = {en}
}
@article{SchrueferBrockowStoevesandtetal.2020,
  author    = {Schr{\"u}fer, Philipp and Brockow, Knut and Stoevesandt, Johanna and Trautmann, Axel},
  title     = {Predominant patterns of beta-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins},
  series = {Allergy, Asthma \& Clinical Immunology},
  volume    = {16},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  doi       = {10.1186/s13223-020-00488-0},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-231306},
  year      = {2020},
  abstract  = {Background Penicillins and other beta-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific beta-lactams are scarce and inconsistent. We aimed to determine patterns of beta-latam allergy, i.e. the association of a clinical reaction type with a specific beta-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected beta-lactam hypersensitivity over a period of 11 years in a single German Allergy Center. Results beta-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3\%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1\%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7\%). Intradermal testing proved to be the most useful method for diagnosing beta-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3\%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all beta-lactam allergic patients tolerated at least one, usually several alternative substances out of the beta-lactam group. Conclusions We identified two patterns of beta-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type beta-lactam hypersensitivity.},
  language  = {en}
}