6^th Pharmacovigilance Congress

Biography

Biography: Dong-Yoon Kang

Abstract

Antibiotic skin test can be used for evaluating sensitization in patients with a history of antibiotics allergy. In many Asian countries including Korea, a routine unconditional pretest before using beta-lactam antibiotics is widely performed, but its clinical value for predicting allergic reaction in patients without prior reaction is not established. The aim of this study is to assess the actual conditions of cephalosporin skin test performed in a current clinical practice. From 2004 to 2015, nursing statements on antibiotics skin test and history of allergy or adverse drug reaction were collected from nursing records of adult inpatients. A total 86,822 cases of cephalosporin skin tests with 15 kinds of cephalosporins (cefazolin, ceftriaxone, flumoxef, cefotaxime, cefotetan, cefoxitin, ceftizoxime, cefodizime, cefepime, ceftazidime, cefpiramide, cefuroxime, cefmetazole, cephalothin, and cefotiam) were included in the study. Among the total of 86,832 cases; 1,139 cases (1.3%) showed positive results on intradermal skin tests. Cefotiam showed highest positive rate (42.7%) and cefuroxime was the lowest positive rate (0.55%). Comparing the result of cephalosporin skin test by a history of allergic disease or adverse reaction to any drugs, patients with the previous history of allergy or adverse drug reaction had higher positive rate than patients without (1.83% vs. 1.27, p<0.001). Interestingly, this correlation was reproduced only in cefazolin (3.26% vs. 1.43%, p=0.023) and cefotetan (3.91% vs. 1.01%, p=0.006) especially in association with any allergy history. However, validation in another institute shows different correlation of each cephalosporins. In conclusion, cephalosporin skin test positivity has weak association with allergy history of patients and varied according to individual cephalosporin. Doing skin test only in patients with allergy history is not clinically applicable.