Evidence map›Paper›PMID 32446963›Full record

SynthesisThe Journal of allergy and clinical immunology2021

Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis.

Bernardo Sousa-Pinto, Isabel Tarrio, Kimberly G Blumenthal, Luís Araújo, Luís Filipe Azevedo, Luís Delgado, João Almeida Fonseca

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Journal of allergy and clinical immunology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07002814 (Feasibility of Direct Oral Challenges in Private Practice Setting for the Evaluation of Mild Delayed Reactions to Beta-lactams in Children), which is not on this map. Cited by 45 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07002814 recruitingnot on this mapstarted 2026, after this paper: background citation

Feasibility of Direct Oral Challenges in Private Practice Setting for the Evaluation of Mild Delayed Reactions to Beta-lactams in Children

TypeobservationalSponsorAssistance Publique - Hôpitaux de ParisRan2026 to 2027Enrolled200ConditionsAllergy
3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
  2. Quality and Consistency of Penicillin Allergy Delabelling Guidelines: A Systematic Review.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
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  8. Trial
  9. Article
  10. Article
  11. Review
  12. Implementing PEN-FAST for penicillin allergy delabeling in a high-prevalence population.Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG · 2026
    Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Towards standardized skin testing for drug-induced allergic reactions.Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society · 2025
    Review
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Bernardo Sousa-PintoMEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: bernardo@med.up.pt.
Isabel TarrioMEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
Kimberly G BlumenthalDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Luís AraújoCINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.
Luís Filipe AzevedoMEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
Luís DelgadoCINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.
João Almeida FonsecaMEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.

Funding

The Clinical and Economic Impact of Penicillin AllergyK01AI125631 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI BLUMENTHAL, KIMBERLY GOLD · 2016 to 2021
$779k
NIAID NIH HHS K01 AI125631
6 · The paper itself

Abstract

backgroundHaving a penicillin allergy label associates with a higher risk for antibiotic resistance and increased health care use.

objectiveWe sought to assess the accuracy of skin tests and specific IgE quantification in the diagnostic evaluation of patients reporting a penicillin/β-lactam allergy.

methodsWe performed a systematic review and diagnostic accuracy meta-analysis, searching on MEDLINE, Scopus, and Web of Science. We included studies conducted in patients reporting a penicillin allergy and in whom skin tests and/or specific IgE quantification were performed and compared with drug challenge results. We quantitatively assessed the accuracy of diagnostic tests with bivariate random-effects meta-analyses. Meta-regression and subgroup analyses were performed to explore causes of heterogeneity. Studies' quality was evaluated using QUADAS-2 criteria.

resultsWe included 105 primary studies, assessing 31,761 participants. Twenty-seven studies were assessed by bivariate meta-analysis. Skin tests had a summary sensitivity of 30.7% (95% CI, 18.9%-45.9%) and a specificity of 96.8% (95% CI, 94.2%-98.3%), with a partial area under the summary receiver-operating characteristic curve of 0.686 (I

conclusionsSkin tests and specific IgE quantification appear to have low sensitivity and high specificity. Because current evidence is insufficient for assessing the role of these tests in stratifying patients for delabeling, we identified key requirements needed for future studies.

Indexed as

Drug HypersensitivityHumansImmunoglobulin EPenicillinsSkin TestsImmunoglobulin EPenicillinsDiagnostic accuracydrug provocation testIgE quantificationpenicillin allergyskin tests

Identifiers

PMID32446963
PMCPMC8019189

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.