Accuracy of Skin Tests and Immunoglobulin E Quantification in Penicillin Allergy

Skin tests and specific immunoglobulin E (IgE) quantification had high specificity and low sensitivity in identifying patients who may develop a hypersensitivity reaction associated with penicillin exposure, according to study results published in the Journal of Allergy and Clinical Immunology.

Researchers conducted a systematic review and meta-analysis of 105 primary studies that reported a penicillin/β-lactam allergy in patients who received skin tests and/or specific IgE quantification. Only studies that compared these tests with a drug provocation test (DPT) were included. In the pooled analysis, there were 31,761 individuals. The accuracy of diagnostic tests was quantitatively assessed using bivariate random-effects meta-analyses in 27 studies.

In the meta-analysis of the 27 studies, skin tests featured a summary sensitivity of 30.7% (95% CI, 18.9%-45.9%) and specificity of 96.8% (95%CI, 94.2%-98.3%). The partial area under the summary receiver operating characteristics (ROC) curve for skin tests was 0.686 (I²= 38.2%). Similarly, specific IgE featured a summary sensitivity of 19.3% (95% CI, 12.0%-29.4%) and a specificity of 97.4% (95% CI, 95.2%-98.6%). Specific IgE had a partial area under the summary ROC curve of 0.420 (I²= 8.5%). Additionally, skin prick tests featured a summary sensitivity and specificity of 29.9% (95% CI, 15.0%-50.8%) and 95.1% (95% CI, 88.1%-98.0%), respectively.

This analysis was limited by the inclusion of only a small number of studies that performed DPT in patients with positive index and the possibility of selection bias.

The investigators wrote that “[a]s current evidence is insufficient for assessing the role of these tests in stratifying patients for delabeling, we identified key requirements needed for future studies.”

Accuracy of Skin Tests and Immunoglobulin E Quantification in Penicillin Allergy

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