Cutaneous Manifestations of Systemic Infections

Cherry, James D.

doi:10.1016/b978-1-4160-4044-6.50069-8

Cited by 4 publications

(1 citation statement)

References 161 publications

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“…19 The rate of exanthema in viral infection is highly variable depending on the virus. 29 In children, rashes are less commonly caused by BL hypersensitivity than in adults. 30 In addition, diagnostic procedures, such as intradermal STs for BL hypersensitivity, are painful and less tolerated in this age group.…”

Section: Discussionmentioning

confidence: 99%

Oral Challenge without Penicillin Skin Tests in Children with Suspected Beta-Lactam Hypersensitivity

Atakul

Köse

Atay

et al. 2022

Journal of Child Science

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Objective A misdiagnosed “penicillin allergy” is a common problem in childhood. Recently, skipping skin tests (STs) and performing a direct oral challenge test (OCT) have become an increasingly common approach in children with suspected β-lactam (BL) allergy. In our study, we aimed to evaluate the safety and efficacy of OCT without using ST in children who had a history of hypersensitivity reactions with BL antibiotics. Materials and Methods We retrospectively evaluated direct OCT outcomes in children with both nonimmediate and immediate-type reaction history with BL antibiotics. STs were not performed before the challenge test. The patients were monitored for 4 hours after the challenge and continued using the drug in two divided doses for 3 days at home. Results In this study, 72 patients were included, with median age of 7 years (interquartile range: 4; min: 1 year to max: 16 years), and of these, 56% were male. Forty-five subjects (63%) reported immediate-type adverse reactions. The most common clinical manifestation was urticaria/angioedema (51%, n: 37) and maculopapular exanthema in 46% (n: 33) of patients, respectively. The most commonly suspected drug was 71% amoxicillin-clavulanate. A 3-day OCT without preceding ST was performed in all patients. Only three patients (4.2%) showed a positive response to the oral drug challenge test. None of these reactions observed was more severe than index reactions. Conclusion Performing OCT without STs is a safe and convenient method to exclude BL hypersensitivity in the pediatric age group.

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Section: Discussionmentioning

confidence: 99%