{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T04:02:13Z","timestamp":1779854533336,"version":"3.53.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":42,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Allergy Asthma Clin Immunol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Hypersensitivity to beta-lactams (BL) is the most frequent drug allergy, and skin testing (ST) remains the first-line diagnostic tool. Although generally safe, systemic reactions (SR) during ST are a concern. We conducted a 7-year ambispective study (2018\u20132025) including 216 adults with confirmed immediate hypersensitivity reactions (HSR) to BL, established by positive skin tests (ST) or drug challenge tests (DCT). Among them, 138 (63.9%) had positive ST, predominantly intradermal tests (IDT; 93.5%). Five patients (3.6% of ST-positive; 2.3% of the entire cohort) developed SR during ST, all after IDT following negative skin prick tests (SPT). Reactions were mostly mild (urticaria, generalized pruritus, erythema), although one anaphylaxis occurred. All were rapidly controlled with symptomatic treatment. Surprisingly, all patients with SR had urticaria\u2013angioedema as their index reaction; none had experienced prior anaphylaxis. A significant shorter time interval between the index reaction and allergy evaluation was observed in SR patients (mean 23.6 vs. 48.8\u00a0months,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02). No significant associations were identified for age, sex, culprit BL, or specific IgE. SR during BL ST are infrequent but clinically relevant. SPT appears highly safe, whereas IDT requires particular caution, especially when performed shortly after the index reaction.\n                  <\/jats:p>","DOI":"10.1186\/s13223-026-01032-2","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T10:45:23Z","timestamp":1776249923000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Frequency and severity of systemic reactions during beta-lactam skin testing in adults with immediate hypersensitivity allergy"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5247-4564","authenticated-orcid":false,"given":"Patricia","family":"Let\u00f3n-Cabanillas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Noguerado-Mellado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Quijada-Morales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gema","family":"Salas-Parra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Rojas-P\u00e9rez-Ezquerra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"1032_CR1","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.1111\/all.14122","volume":"75","author":"A Romano","year":"2020","unstructured":"Romano A, Atanaskovic-Markovic M, Barbaud A, Bircher AJ, Brockow K, Caubet JC, et al. Towards a more precise diagnosis of hypersensitivity to beta-lactams\u2014an EAACI position paper. Allergy. 2020;75:1300\u201315.","journal-title":"Allergy"},{"key":"1032_CR2","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/j.jaci.2015.03.012","volume":"136","author":"A Romano","year":"2015","unstructured":"Romano A, Gaeta F, Valluzzi RL, Maggioletti M, Zaffiro A, Caruso C, et al. IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of alternative cephalosporins. J Allergy Clin Immunol. 2015;136:685\u201391.","journal-title":"J Allergy Clin Immunol"},{"key":"1032_CR3","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.jaci.2004.04.029","volume":"114","author":"SG Brown","year":"2004","unstructured":"Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004;114:371\u20136.","journal-title":"J Allergy Clin Immunol"},{"key":"1032_CR4","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1159\/000324461","volume":"156","author":"A Antico","year":"2011","unstructured":"Antico A, Pagani M, Compalati E, Vescovi PP, Passalacqua G. Risk assessment of immediate systemic reactions from skin tests with \u03b2-lactam antibiotics. Int Arch Allergy Immunol. 2011;156:427\u201333.","journal-title":"Int Arch Allergy Immunol"},{"issue":"270","key":"1032_CR5","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1001\/jama.1993.03510200062033","volume":"24","author":"J Gadde","year":"1993","unstructured":"Gadde J, Spence M, Wheeler B, Adkinson NF Jr. Clinical experience with penicillin skin testing in a large inner-city STD clinic. JAMA. 1993;24(270):2456\u201363.","journal-title":"JAMA"},{"key":"1032_CR6","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1016\/S1081-1206(10)62546-X","volume":"85","author":"MA Valyasevi","year":"2000","unstructured":"Valyasevi MA, Van Dellen RG. Frequency of systematic reactions to penicillin skin tests. Ann Allergy Asthma Immunol. 2000;85:363\u20135.","journal-title":"Ann Allergy Asthma Immunol"},{"key":"1032_CR7","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.jaci.2005.10.020","volume":"117","author":"HB Co Minh","year":"2006","unstructured":"Co Minh HB, Bousquet PJ, Fontaine C, Kvedariene V, Demoly P. Systemic reactions during skin tests with beta-lactams: a risk factor analysis. J Allergy Clin Immunol. 2006;117:466\u20138.","journal-title":"J Allergy Clin Immunol"},{"key":"1032_CR8","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1159\/000533641","volume":"185","author":"C Karavaizoglu","year":"2024","unstructured":"Karavaizoglu C, Suleyman A, YavuzAl\u0131c R, Dolu KO, Yucel E, Demirkale ZH, et al. Drug allergy in children: adverse reactions after skin testing. Int Arch Allergy Immunol. 2024;185:56\u201362.","journal-title":"Int Arch Allergy Immunol"},{"key":"1032_CR9","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/S0091-6749(87)80164-1","volume":"79","author":"RF Lockey","year":"1987","unstructured":"Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol. 1987;79:660\u201377.","journal-title":"J Allergy Clin Immunol"},{"issue":"3","key":"1032_CR10","first-page":"853587","volume":"8","author":"S Luliano","year":"2022","unstructured":"Luliano S, Senn L, Moi L, Muller YD, Ribi C, Buss G, et al. Management of beta-lactam antibiotics allergy: a real-life study. Front Allergy. 2022;8(3):853587.","journal-title":"Front Allergy"}],"container-title":["Allergy, Asthma &amp; Clinical Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13223-026-01032-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-026-01032-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-026-01032-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T03:05:04Z","timestamp":1779851104000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13223-026-01032-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1032"],"URL":"https:\/\/doi.org\/10.1186\/s13223-026-01032-2","relation":{},"ISSN":["1710-1492"],"issn-type":[{"value":"1710-1492","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"assertion":[{"value":"6 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have obtained the informed consent of the patients and\/or subjects mentioned in the article. The author for correspondence is in possession of this document.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed written consent to participate in that study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"35"}}