Positive penicillin allergy testing results: a systematic review and meta-analysis of papers published from 2010 through 2015
Bibliographic record
Abstract
β-lactam antibiotics are the most widely used group of antibiotics, given their effectiveness for the most common bacterial pathogens and their relatively low price. Adverse reactions, mainly cutaneous, are often reported to be associated with their use and hence, less effective and usually more costly alternative antibiotics are prescribed. However, it is not clear what is the risk of immediate immune-mediated (i.e. developing within one hour of administration) and potentially life-threatening reactions among those using β-lactam antibiotic. We conducted a systematic review to assess the prevalence of immediate adverse reactions to β-lactam antibiotics, specifically penicillin derivatives, in patients with a reported adverse reaction to β-lactam antibiotics. In addition, we determined the effect of age on the prevalence of immediate reactions. Assessing the true risk of using β-lactam antibiotics in patients with a reported allergy could prevent physicians from unnecessarily discouraging the use of β-lactam antibiotics. We conducted a systematic review and a meta-analysis using the PubMed, OVID, and Embase databases of work published in English and in French in the last 5 years. Studies were only eligible if they established the prevalence of immediate penicillin reactions with skin testing or challenges in case of negative skin tests. The meta-analysis was conducted using Stata version 12.0. The prevalence of immediate reactions to penicillin derivatives in patients reporting a β-lactam hypersensitivity is 1.98% (95%CI; 1.35%, 2.60%) in the pediatric (under 18 years old) group, 7.78% (95%CI; 6.53%, 9.04%) in the adult group, and 2.84% (95%CI; 1.77%, 3.91%) in the combined group, as tested in various studies, using skin tests and oral challenges. The I(2) value ranged between 87.2% and 97.0%. Our results indicate that the prevalence of immediate reactions is higher in adults than in children. However, wide confidence intervals and a large study heterogeneity preclude conclusive estimates.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.023 | 0.003 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".