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ICU, corticosteroids increase odds of negative histamine skin tests

Performing skin tests to evaluate antibiotic hypersensitivity among inpatients required caution and consideration when considering results, according to study results.

Admission to the ICU, use of systemic corticosteroids and older age during skin testing were linked to patients’ increased likelihood of a negative histamine response.

Bob Geng

Bob Geng, MD, division of clinical immunology and allergy at the University of California, Los Angeles, and colleagues used a retrospective case-and-control design study and obtained data from UCLA inpatient penicillin skin testing records from 2010 to 2013. Histamine control showed a negative reaction among 52 patients in the cohort. An additional 125 patients with normal histamine response served as controls.

The researchers sought to determine if any factors were associated with a negative histamine test response.

Being admitted to the ICU (OR = 8.18; 95% CI, 3.22-20.76) was associated with a significant difference between patients with negative histamine response (73.1%) and controls (33.6%). Systemic corticosteroid use also was more likely to result in a negative histamine response (OR = 3.76; 95% CI, 1.3-10.92), and each 1-year increase in a patient’s age also correlated with greater odds of a negative response (OR = 1.04; 95% CI, 1.01-1.07).

“This is the largest study on factors that may negatively affect the utility of skin testing in the inpatient setting,” Geng told Healio.com/Allergy. “Admission to the ICU, systemic steroids, H2-blockers and older age are all independent factors that are associated with a higher probability of negative histamine response rendering skin test results indeterminate.” – by Ryan McDonald

Disclosure: The researchers report no relevant financial disclosures.