Jean-Christoph Roger J-P Caubet, Anca-Mirela Chiriac, Paul Whitaker, Lene H. Garvey, Annick Barbaud, Alla Nakonechna, Andreas J. Bircher, Gülfem Çelik, María José Torres, Antonino Romano, Cristobalina Mayorga, Josefina Cernadas, Pascal Demoly, Knut Brockow, Marina Atanaskovic-Markovic, University of Catania [Italy], School of Medecine [Belgrade], University of Belgrade [Belgrade], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University Hospital Basel [Basel], Department of Dermatology and Allergy Biederstein, Technische Universität Munchen - Université Technique de Munich [Munich, Allemagne] (TUM), Geneva University Hospital (HUG), Ankara University School of Medicine [Turkey], Immunoallergy Department [Porto], Centro Hospitalar São João EPE, Faculdade de Medicina da Universidade do Porto (FMUP), Universidade do Porto, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Department of Clinical Medicine [Copenhagen], Bispebjerg Hospital-Faculty of Health and Medical Sciences, University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU), Biomedical Research Institute of Málaga (IBIMA), Universidad de Málaga [Málaga] = University of Málaga [Málaga], Allergy and Immunology Clinic [Royal Liverpool and Broadgreen University Hospital], Royal Liverpool and Broadgreen University Hospital NHS Trust, University of Liverpool, Salvy-Córdoba, Nathalie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Universidade do Porto = University of Porto, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH)
International audience; A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with beta-lactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost-effective, as possible. For this purpose, a bibliographic search on large studies regarding BL hypersensitivity diagnosis was performed by an EAACI task force, which reviewed and evaluated the literature data using the GRADE system for quality of evidence and strength of recommendation. The updated guidelines provide a risk stratification in BL hypersensitivity according to index reaction(s), as well as an algorithmic approach, based on cross-reactivity studies, in patients with a suspicion of BL hypersensitivity and an immediate need for antibiotic therapy, when referral to an allergist is not feasible. Furthermore, the update addresses availability and concentrations of skin test (ST) reagents, ST and drug provocation test (DPT) protocols, as well as diagnostic algorithms and administration of alternative BL in allergic subjects. Specifically, distinct diagnostic algorithms are suggested depending on risk stratification of the patient into high and low risk based on the morphology and chronology of the reaction, immediate (i.e., occurring within 1 to 6 hours after the last administered dose) or nonimmediate (i.e., occurring more than 1 hour after the initial drug administration), and the reaction severity. Regarding the allergy workup, the main novelty of this document is the fact that in some low-risk nonimmediate reactions ST are not mandatory, especially in children. For DPT, further studies are necessary to provide data supporting the standardization of protocols, especially of those regarding nonimmediate reactions, for which there is currently no consensus.