Relevance of the determination of serum-specific IgE antibodies in the diagnosis of immediate beta-lactam allergy

Allergy. 2007 Jan;62(1):47-52. doi: 10.1111/j.1398-9995.2006.01268.x.


Background: Allergic reactions to beta-lactams are the most frequent cause of adverse drug reactions mediated by specific immunologic mechanisms. They can be explored by in vivo and/or in vitro tests. The measurement of serum-specific immunoglobulin E (IgE) presents several advantages: safety, simplicity, and availability to nonallergologist physicians.

Objectives: To establish the diagnostic value of specific IgE determination in the diagnosis procedure of immediate beta-lactam allergy.

Methods: The in vitro determination of beta-lactam-specific IgE antibodies was compared in three well-defined groups of patients (n=45): one with negative skin tests and a positive drug provocation test, another with positive skin tests, and a third control exposed population with good tolerance. Two techniques were used: the CAP-FEIA system (Phadia) commercially available and a homemade radioallergosorbent test (RAST).

Results: The specificity of CAP-FEIA ranged from 83.3% to 100% and sensitivity from 0% to 25% depending on initial clinical manifestations. The specificity of RAST was between 66.7% and 83.3% and sensitivity 42.9% and 75%. In the subgroup of patients with an anaphylactic shock and negative skin tests, the sensitivity and specificity of RAST were 75%. Positive and negative predictive values were 45.5% and 77.1% with CAP-FEIA and 38.5% and 81.5% with RAST, respectively.

Conclusion: These results indicate that, although the specificity of beta-lactam-specific IgE measurement is good, sensitivity is low. Immunoglobulin E measurement should be limited to patients with a clinical history of anaphylactic shock and negative skin tests in order to avoid a drug provocation test. More sensitive assays should be developed.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cephalosporins / adverse effects
  • Cephalosporins / immunology
  • Child
  • Drug Hypersensitivity / diagnosis*
  • Female
  • Humans
  • Hypersensitivity, Immediate / diagnosis*
  • Immunoglobulin E / blood*
  • Male
  • Middle Aged
  • Penicillins / adverse effects
  • Penicillins / immunology
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Skin Tests
  • beta-Lactams / adverse effects*
  • beta-Lactams / immunology*


  • Cephalosporins
  • Penicillins
  • beta-Lactams
  • Immunoglobulin E