Allergy to betalactam antibiotics in children: a prospective follow‐up study in retreated children after negative responses in skin and challenge tests

Ponvert, C.; Weilenmann, C.; Wassenberg, Jacqueline; Walecki, Piotr; Bourgeois, M. Le; Blic, J. de; Scheinmann, P.

doi:10.1111/j.1398-9995.2006.01246.x

Cited by 90 publications

(72 citation statements)

References 25 publications

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“…Moreover, in patients with negative initial work-up, 52 (95%) out of 55 patients actually tolerated courses of penicillin therapy without reaction before the repeated testing was performed. High negative predictive value (NPV) of b-lactam DPT of 98 and 94% has been confirmed in other large studies involving 256 children (by Ponvert et al [32]), and 457 patients (by Demoly et al [33 ]), respectively, and most of the reactions reported by patients were nonimmediate and not severe. This information should reassure the patients and their doctors in prescribing drugs with negative work-ups.…”

Section: Negative Predictive Value Of Drug Provocation Testsupporting

confidence: 59%

Drug provocation tests in hypersensitivity drug reactions

Rerkpattanapipat

Chiriac²,

Demoly³

2011

Current Opinion in Allergy &Amp; Clinical Immunology

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Section: Negative Predictive Value Of Drug Provocation Testsupporting

confidence: 59%

Drug provocation tests in hypersensitivity drug reactions

Rerkpattanapipat

Chiriac²,

Demoly³

2011

Current Opinion in Allergy &Amp; Clinical Immunology

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“…The risk of resensitization is low. It is unnecessary to repeat skin testing before every course of treatment [224,233].…”

Section: Cross-reactivity and Resensitizationmentioning

confidence: 99%

“…True allergic reactions to beta-lactams are less common in children than adults [96,224]. Children treated with beta-lactams frequently develop skin rashes.…”

Section: Beta-lactam Allergy In Children Introductionmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

217

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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“…A well-tolerated OC may theoretically boost a latent sensitization, and be responsible for a reaction during subsequent treatment [61,74,75] . However, the risk of resensitization by OC appears very low [76,77] . Finally, skin tests and OC diagnosed cross-reactivity between penicillins and cephalosporins themselves, and penicillins and cephalosporins, in 25-84.2% of the children with immediate-type HS [46,63] .…”

Section: ␤ -Lactamsmentioning

confidence: 98%

Allergy and Pseudoallergy to Drugs and Vaccines in Children

Ponvert¹,

Hadj‐Rabia²,

Scheinmann³

2007

Drug Hypersensitivity

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Five to 20% of subjects of all ages report suspected allergic reactions to drugs and biological substances. Children may be less affected than adults, but this difference is disputed and probably results from differences in drug exposure. Antibiotics, mainly ␤ -lactams, antipyretics, analgesics and non-steroidal anti-inflammatory drugs, are most frequently incriminated. The most common reactions are morbilliform/maculopapular rashes, urticaria and angioedema. Other cutaneous and systemic reactions and severe anaphylactic/anaphylactoid reactions are rare. Diagnosis is based on a detailed clinical history, skin and/or in vitro tests (if possible and if validated) and challenge tests (if indicated). Prevention of relapse is based on a rigorous avoidance of the responsible and cross-reacting drugs. The results of the allergological work-up, including challenge, are often negative, suggesting that, in many instances, the drug can be tolerated again. This is especially the case in mild to moderately severe reactions such as maculopapular exanthems, non-immediate urticarias and unidentified rashes. In these cases, the reaction may result from a complex interaction between 'danger' signals provided by the underlying disease and a weak and transient drug-specific immune reaction. However, severe reactions like anaphylaxis (caused by myorelaxants, etc.), bullous skin reactions or drug-induced rash with eosinophilia and systemic symptoms (antiepileptics), require the same precautions as in adults and strict avoidance of the incriminated drug, even if the test results are negative.

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Allergy to betalactam antibiotics in children: a prospective follow‐up study in retreated children after negative responses in skin and challenge tests

Cited by 90 publications

References 25 publications

Drug provocation tests in hypersensitivity drug reactions

Drug provocation tests in hypersensitivity drug reactions

Management of allergy to penicillins and other beta‐lactams

Allergy and Pseudoallergy to Drugs and Vaccines in Children

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