Intradermal testing increases the accuracy of an immediate-type cefaclor hypersensitivity diagnosis

Ji-Hyang Lee, MD, PhD; Chan Sun Park, MD, PhD; Min Ju Pyo, BS; A. Ryang Lee, BS; Eunyong Shin, MD; Young-Sang Yoo, MD; Woo-Jung Song, MD, PhD; Tae-Bum Kim, MD, PhD; You-Sook Cho, MD, PhD; Hyouk-Soo Kwon, MD, PhD

World Allergy Organization Journal (Apr 2022)

Intradermal testing increases the accuracy of an immediate-type cefaclor hypersensitivity diagnosis

Ji-Hyang Lee, MD, PhD,
Chan Sun Park, MD, PhD,
Min Ju Pyo, BS,
A. Ryang Lee, BS,
Eunyong Shin, MD,
Young-Sang Yoo, MD,
Woo-Jung Song, MD, PhD,
Tae-Bum Kim, MD, PhD,
You-Sook Cho, MD, PhD,
Hyouk-Soo Kwon, MD, PhD

Affiliations

Ji-Hyang Lee, MD, PhD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Chan Sun Park, MD, PhD: Department of Allergy and Clinical Immunology, Inje University of College of Medicine, Haeundae Paik Hospital, Busan, South Korea
Min Ju Pyo, BS: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
A. Ryang Lee, BS: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Eunyong Shin, MD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Young-Sang Yoo, MD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Woo-Jung Song, MD, PhD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Tae-Bum Kim, MD, PhD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
You-Sook Cho, MD, PhD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Hyouk-Soo Kwon, MD, PhD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Corresponding author. Hyouk-Soo Kwon, M.D., Ph.D.; Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.

Journal volume & issue: Vol. 15, no. 4
p. 100643

Abstract

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Background: Hypersensitivity reactions to cefaclor have increased in accordance with its frequent use. However, only limited data are available on the diagnostic value of skin tests for these conditions, particularly intradermal tests (IDTs). Objective: To evaluate the clinical usefulness of IDT compared to the ImmunoCAP test in patients with cefaclor-induced immediate-type hypersensitivity. Methods: We conducted a retrospective chart review from January 2010 to June 2020 of adult subjects from 2 tertiary hospitals in Korea with a history of suspected immediate-type hypersensitivity to cefaclor, and who had undergone ImmunoCAP and IDT. Results: Overall, 131 subjects diagnosed with cefaclor hypersensitivity were included in the analysis. Fifty-nine patients (59/131, 45.04%) were positive in both IDT and ImmunoCAP. Fifty-four (54/131, 41.22%) and 6 (6/131, 4.58%) subjects showed positive results only with IDT or the ImmunoCAP test, respectively. Twelve subjects (12/131, 9.16%) were negative by both tests but reacted positively in a drug provocation test. The frequency of IDT positivity was similar regardless of the severity of reactions. However, positivity of ImmunoCAP was lower in subjects with mild reactions compared to those with anaphylaxis. Regarding the diagnosis of cefaclor hypersensitivity, the overall sensitivity of IDT and ImmunoCAP was 0.863 and 0.496, respectively while the specificity was 1. The combination of IDT and ImmunoCAP further increased this sensitivity to 0.908. Conclusion: IDT was more sensitive than ImmunoCAP for the diagnosis of cefaclor allergy, regardless of the severity of the hypersensitivity reaction. Therefore, we recommend a combination of IDT and ImmunoCAP for the diagnosis of cefaclor hypersensitivity.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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