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Page 2
American perspective
European perspective
Comment
General rules
Evaluation mainly by signs and symptoms In history of severe reactionsa: avoidance of allergy tests In history of non-severe reactions: diagnostic approach can be applied
Evaluation by clinical history and allergy tests
Different
DPTs
Recommended if other diagnostic tools are negative Consider contraindications
Recommended if other diagnostic tools are negative Consider contraindications
Similar
Desensitization
Recommended Consider indications and contraindications
Recommended Consider indications and contraindications
Similar
Immediate reactions
General rules
SPTs followed by IDTs are the first to perform Perform DPTs if STs are negative
SPTs followed by IDTs are the first to perform Perform DPTs if STs and in vitro tests are negative
PTs followed by delayed-reading IDTs are recommended in routine approach In case of positive PTs, IDTs may be avoided
Different
In vitro tests
Not recommended
Not recommended
Similar
Retest
Repeating penicillin STs routinely is not indicated in patients with a history of non-severe penicillin reactions who have tolerated 1 or more oral penicillin courses
Weakly recommended: retesting (2–4 weeks later) patients who suffered severe immediate reactions to BLs and display negative results in the first allergy evaluation, including DPTs
DPTs drug provocation tests, STs skin tests, SPTs skin prick tests, IDTs intradermal tests, PTs patch tests, PPL benzylpenicilloyl-poly-l-lysine, POL benzylpenicilloyl-octa-l-lysine, MDM minor determinant mixture, MD minor determinant, BP Benzylpenicillin, AX amoxicillin, AMP ampicillin, sIgE specific IgE