Optimisation of diagnosis of IgE-mediated ß-lactam allergy in the outpatient allergy clinic of the Erasmus MC Rotterdam.

Wijnmaalen, I.M. (2013) Optimisation of diagnosis of IgE-mediated ß-lactam allergy in the outpatient allergy clinic of the Erasmus MC Rotterdam. thesis, Medicine.

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Abstract

Introduction: An accurate diagnosis of IgE-mediated ß-lactam allergy is essential. However, many negative skin test results in patients with ß-lactam hypersensitivity reactions, vague reaction descriptions from patients, misunderstanding of cross-reactions between members of the BLs and vague or incomplete referral letters represent major problems in diagnosing IgE-mediated ß-lactam allergy. In this study prevalence, way of diagnosing, referral of patients with assumed ß-lactam allergy and costs of IgE-mediated ß-lactam allergy at the allergy clinic in the Erasmus MC in Rotterdam were retrospectively studied. Materials and methods: 336 patients who underwent ß-lactam skin tests in the outpatient clinic of allergy in the Erasmus MC in Rotterdam in the period between January 2008 and October 2012 were included. A database was developed in which information about patient characteristics, referral letter, drug reactions, diagnostic test results, diagnosis, therapeutical advice and costs was collected. Results: Mean prevalence of ß-lactam allergy was 0,8% a year in the allergy clinic population. In vitro assays, skin tests and provocation tests together were positive in 15,5% of the patients. Diagnosis of 7,4% of the patients was still unknown after diagnostic evaluation. In 9,8% no therapeutical advice was given. With incorrect or incomplete referral letters, more skin tests were performed. Patients with the initial reaction more than 5 days after first ß-lactam intake, with unacceptable symptoms or referred for specific drug allergy did not need to be tested because of only negative diagnostic test results (N=59, 17,6%). Mean skin test costs for each patient were € 162,35 and mean visiting costs were about € 495,20 ± € 168,46 for each patient. Conclusion: In only 15,5% of the patients tested for ß-lactam allergy in the outpatient allergy clinic, this allergy could be confirmed. Examples of improving the diagnosis of ß-lactam allergy are standardisation of the referral letter, altering the selection of patients for ß-lactam diagnostic tests and altering the method of evaluating skin tests. More education should be given to general practitioners to prevent them from unnecessary referrals. This is most likely cost-effective and causes less burden for many patients.

Item Type:	Thesis (Thesis)
Supervisor name:	onbekend
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:38
Last Modified:	25 Jun 2020 10:38
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/32

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