A new risk stratification tool

METHODOLOGY:

To develop and validate CA4TCH, researchers conducted a retrospective study of 1035 patients who presented with suspected NSAID hypersensitivity at the allergy unit of the University Hospital of Montpellier in Montpellier, France, between February 2001 and December 2020 and underwent drug provocation testing.
Using elements of the clinical history — including sex; age at the last reaction; reaction onset ≤ 24 hours; whether the last reaction occurred in the past 5 years; history of anaphylaxis or respiratory symptoms; reactions to two or more drug classes; reaction to aspirin; and comorbid atopy, asthma, sinus disease, or chronic spontaneous urticaria — the team constructed a risk score to predict the presence of a drug hypersensitivity reaction.
They then validated the risk score in an independent cohort of 69 participants from the University Hospital of Tours, Tours, France.

Overall, 232 (22.4%) participants had at least one positive result during drug provocation testing, whereas 803 (77.6%) did not react to the suspected culprit NSAIDs.
The CA4TCH tool had a sensitivity of 78.4%, specificity of 70.4%, and positive and negative predictive values of 43.3% and 91.9%, respectively.
Among participants with a negative result, the model successfully delabeled 565 of 803 cases (70.4%). In these cases, past symptoms commonly included angioedema, urticaria, or pruritus.
External validation showed comparable predictive performance.

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