BackgroundResearch suggests that 90% of patients labeled beta-lactam allergic are able to tolerate penicillins following further assessment. This study aims to define and describe the frequency of true beta-lactam allergy following allergy patient evaluation in a predominantly pediatric population.Methods306 primary care patients referred between January 2010 and June 2015 were assessed for a suspected beta-lactam allergy. Patient demographics, history and test results were extracted from electronic medical records. Testing performed was based on specialist recommendation following review of patient history.Results34% of the study participants had intradermal testing. Oral challenge was given to 96.7% of the sample. 96% of patients with a prior history of beta-lactam allergy were advised that they could re-introduce beta-lactam antibiotics following evaluation.ConclusionsAmong patients with a documented beta-lactam allergy or a recent history of a reaction there is a low rate of ‘true’ beta-lactam allergy. Consistent evaluation of beta-lactam antibiotic allergies can reduce rates of broad spectrum antibiotic prescribing, among other harmful consequences.
RATIONALE: Our group previously showed the safety of peanut oral immunotherapy (OIT) in 270 preschool-aged children (0.4% had severe reactions). The impact of preschool OIT on parental quality of life (QoL) has not been previously described. METHODS: We enrolled preschool-aged children into OIT. The project was conducted in four clinics across Canada (Halifax, Winnipeg, Edmonton, Vancouver). The OIT protocol used capsules and/or food, and the maintenance dose was 300mg of protein daily. The 17-item Food Allergy Quality of Life-Parental Burden (FAQL-PB) questionnaire was administered to parents at baseline and end of build-up, and Wilcoxon signed-rank test was performed to compare the FAQL-PB scores between timepoints. RESULTS: Between May/2019-August/2020, 29 patients aged 9-32.3 months (58.6% males) completed OIT (28 peanut, 1 sesame), and FAQL-PB questionnaires. There was a significant improvement in FAQL-PB from baseline to end of build-up with a median change in score of -14 ((IQR: -33.5, -7.5); p<0.00001), representing a change of 0.82 in mean total score (> _0.5 is considered a minimal clinically important difference [MCID]). CONCLUSIONS: Our real-world study found that preschool OIT improves parent QoL from baseline to end of build-up (exceeding the MCID), even though families may be most fearful of potential reactions during this period based on reaction risks described in older children. This reduction in parental burden is most likely associated with the superior safety experienced by families of preschoolers. Future work will involve analyzing QoL at various timepoints during maintenance, to determine whether improvement in QoL holds over time.
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