Approach for delabeling beta-lactam allergy in children

Abstract

A considerable number of pediatric patients treated with beta-lactam (BL) antibiotics develop delayed onset of skin rashes during the course of treatment. Although the most frequent cause of these symptoms is infectious, many cases are labeled as allergic reactions to these drugs. BL allergy labels could have a negative impact, as they imply avoidance of this group of drugs and the use of second-line antibiotics, leading to a potential increase in adverse effects and the utilization of less effective therapies. This constitutes a major public health concern and economic burden, as the use of broad-spectrum antibiotics can result in multidrug-resistant organisms and prolonged hospital stays. Therefore, it is crucial to delabel patients during childhood to avoid false labeling in adult life. Although the label of BL allergy is among the most frequent causes of allergy referral, its management remains controversial, and new diagnostic perspectives are changing the paradigm of managing BL allergies in children. Traditionally, drug provocation testing (DPT) was exclusively performed in patients who had previously obtained negative results from skin tests (STs). However, the sensitivity of STs is low, and the role of in vitro testing in the pediatric population is not well defined. Recent studies have demonstrated the safety of direct DPT without prior ST or serum tests for pediatric patients who report a low-risk reaction to BLs, which is cost-effective. However, there is still a debate on the optimal allergic workup to be performed in children with a benign immediate reaction and the management of children with severe cutaneous adverse drug reactions. In this review, we will discuss the impact of the label of BL allergy and the role of the different tools currently available to efficiently address BL allergy delabeling in children.

The Role of Medical History and Allergic Tests in the Analysis of Antibiotic Allergy in the Pediatric Population

“…However, these medications are not always the optimal choice. Approximately 50% of children labeled as allergic to a specific antibiotic end up being treated with a drug that is not recommended for their infection [2]. Additionally, these antibiotics are often more expensive, are associated more frequently with adverse effects, and contribute to the development of antibiotic-resistant microorganisms and a longer hospitalization period [1,[3][4][5][6].…”

“…It is crucial for de-labeling to be implemented early in life to avoid perpetuating this issue into adulthood. In the past, oral provocation testing (OPT) was only performed on patients with previously negative skin tests (STs) [2]. Indeed, STs' specificity is about 97.4%, which means that a positive STs can define a person as allergic to a specific antibiotic [19].…”