Differentiating Between β-Lactam-Induced Serum Sickness–Like Reactions and Viral Exanthem in Children Using a Graded Oral Challenge

Colli, Luca Delli; Gabrielli, Sofianne; Abrams, Elissa M.; O’Keefe, Andrew; Protudjer, Jennifer; Lavine, Elana; Pitt, Tracy; Atkinson, Adelle; Eiwegger, Thomas; McCusker, Christine; Ben‐Shoshan, Moshe

doi:10.1016/j.jaip.2020.08.047

Cited by 21 publications

(20 citation statements)

References 18 publications

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“…When a label of penicillin allergy seems inevitable in a child we should address this label early and pay particular attention to antibiotic stewardship. New data on serum sickness‐like reaction suggest that many of these are likely virally mediated and do not reproduce on ingestion challenge 3 . Community‐based education programs can help disseminate timely information on penicillin allergy to dispel myths and alleviate fears.…”

Section: Figurementioning

confidence: 99%

“…New data on serum sickness-like reaction suggest that many of these are likely virally mediated and do not reproduce on ingestion challenge. 3 Community-based education programs can help disseminate timely information on penicillin allergy to dispel myths and alleviate fears. A label of penicillin allergy should be both viewed and approached as a threat to both individual and public health.…”

Section: E D I T O R I a L Addressing Beta-lactam Allergy: A Time For...mentioning

confidence: 99%

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Addressing beta‐lactam allergy: A time for action

Phillips

Demoly

Torres

2022

Allergy

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Section: Figurementioning

confidence: 99%

Section: E D I T O R I a L Addressing Beta-lactam Allergy: A Time For...mentioning

confidence: 99%

Addressing beta‐lactam allergy: A time for action

Phillips

Demoly

Torres

2022

Allergy

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“…В числе последних описаны случаи возникновения кольцевидных высыпаний в результате реакции по типу сывороточной болезни (serum sickness-like reactions; SSLR). Клиническая картина данного состояния идентична истинной сывороточной болезни, однако последняя обусловлена развити-ем аллергической реакции типа III [2]. Патогенез SSLR остается малоизученным, а само заболевание ассоциировано с реакцией на лекарственные препараты [3], вакцины [4], вирусные и бактериальные инфекции [5].…”

Section: обоснованиеunclassified

Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case

Ivanchikov

Мурашкин

Амбарчян

et al. 2022

Vopr. sovr. pediatr.

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Background. Annular dermatoses are a group of diseases with major clinical manifestation of rashes of relevant form. This manifestation pattern causes difficulties in diagnosis. The case of rarely diagnosed annular dermatosis is presented: serum siknesslike reaction (SSLR) triggered by the Epstein – Barr virus (EBV). Clinical case description. Patient D., 8 years old girl, noted abdominal pain 3 weeks before hospitalization, and later numerous polymorphic rashes (erythematous macules, urticarial elements), swelling and pain in joints. Self-treatment with non-steroidal anti-inflammatory and systemic antihistamines did not lead to any improvement. The patient was hospitalized in the pediatric department at the place of residence, where the diagnosis “Henoch-Schonlein purpura, mixed type” was established according to the results of physical, laboratory (double increase of ALT and AST, ESR up to 166 mm/h, IgM to EBV), and ultrasound (mesenteric lymph nodes hyperplasia) studies. Systemic glucocorticosteroids have led to improvement, however, few days after the end of the treatment there was relapse of rash and arthralgia. Thus, the girl was administrated to clinical diagnostic center. Patient’s general condition was satisfactory at the time of examination. There were numerous erythematous annular urticarial and macular elements (3–12 cm) on the skin of face, body and limbs. Some foci, as well as some resolved rashes had blue spots with indistinct boundaries that disappeared after compression. Mucous membranes, nails and hair were intact. Subjective symptoms — slight burning around rashes, at palpation — low-intensity pain in the left radiocarpal joint. Blood tests: C-reactive protein concentration increased up to 12 mg/L, ESR up to 26 mm/h, IgG to EBV up to 47.7. Conclusion. During differential diagnosis we should consider the possibility of SSLR development in all pediatric patients with annular rashes associated with arthralgia and/or arthritis, fever, history of drug use (most often beta-lactam antibiotics), recent vaccination or manifestations of viral infection, especially in case of cyanotic spots after rashes resolution and non-specific laboratory parameters.

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“… 1 Children are often misdiagnosed as penicillin allergic because an allergic rash is often difficult to distinguish from viral exanthem. 2 In a large recent study, the median age of obtaining an allergy label was 1.3 years (IQR 0.9–2.3 years), 1 and in children, 75% of penicillin allergy labels (PALs) are obtained by the age of 3 years. 3 …”

Section: Introductionmentioning

confidence: 99%

Health outcomes of penicillin allergy testing in children: a systematic review

Kwok

Heard

May

et al. 2023

Journal of Antimicrobial Chemotherapy

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Background Penicillin allergy labels are commonly acquired in childhood and lead to avoidance of first-line penicillin antibiotics. Understanding the health outcomes of penicillin allergy testing (PAT) can strengthen its place in antimicrobial stewardship efforts. Objectives To identify and summarize the health outcomes of PAT in children. Methods Embase, MEDLINE, Web of Science, Cochrane Library, SCOPUS and CINAHL were searched from inception to 11 Oct 2021 (Embase and MEDLINE updated April 2022). Studies that utilized in vivo PAT in children (≤18 years old) and reported outcomes relevant to the study objectives were included. Results Thirty-seven studies were included in the review, with a total of 8411 participants. The most commonly reported outcomes were delabelling, subsequent penicillin courses, and tolerability to penicillin courses. Ten studies had patient-reported tolerability to subsequent penicillin use, with a median 93.6% (IQR 90.3%–97.8%) of children tolerating a subsequent course of penicillins. In eight studies, a median 97.3% (IQR 96.4%–99.0%) of children were reported as ‘delabelled’ after a negative PAT without further definition. Three separate studies verified delabelling by checking electronic or primary care medical records, where 48.0%–68.3% children were delabelled. No studies reported on outcomes relating to disease burden such as antibiotic resistance, mortality, infection rates or cure rates. Conclusions Safety and efficacy of PAT and subsequent penicillin use was the focus of existing literature. Further research is required to determine the long-term impact of delabelling penicillin allergies on disease burden.

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Differentiating Between β-Lactam-Induced Serum Sickness–Like Reactions and Viral Exanthem in Children Using a Graded Oral Challenge

Cited by 21 publications

References 18 publications

Addressing beta‐lactam allergy: A time for action

Addressing beta‐lactam allergy: A time for action

Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case

Health outcomes of penicillin allergy testing in children: a systematic review

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