Direct Oral Provocation Test Is Safe and Effective in Diagnosing Beta-Lactam Allergy in Low-Risk Children With Mild Cutaneous Reactions

Felix, Mara Morelo Rocha; Kuschnir, Fábio Chigres

doi:10.3389/fphar.2020.01223

Cited by 8 publications

(12 citation statements)

References 27 publications

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“…Previous studies showed that mild and moderate MPEs were considered of low risk, particularly in children. 22 Mild MPE was defined as "a more or less widespread rash, with less than a week of duration, without systemic involvement" and moderate MPE, those with more than a week of duration, without systemic symptoms. 25 Many studies in the literature suggesting direct OCT were conducted on low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…25 Many studies in the literature suggesting direct OCT were conducted on low-risk patients. 20,22,27 Therefore, it is not yet appropriate to apply the direct OCT approach for BL hypersensitivity for all patient groups. It is currently recommended to perform STs first, especially in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…The currently available data show that if a reaction develops in these challenge tests, the severity is usually similar or milder than the index reaction. 19 20 21 22…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

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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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“…BL allergy labels can be removed without testing in patients who had a history of non‐specific symptoms, usually side effects, and were misclassified as allergic. Over the past decade, the generally recommended approach for children with mild cutaneous NIRs to BLs is to consider these subjects as low risk and perform a direct DPT 2,35,36,42,77 . However, other risk situations and diagnostic pathways are not clear in children.…”

Section: Alternative Approaches Mainly Targeting To Delabel Bl Allergymentioning

confidence: 99%

“…Over the past decade, the generally recommended approach for children with mild cutaneous NIRs to BLs is to consider these subjects as low risk and perform a direct DPT. 2, 35,36,42,77 However, other risk situations and diagnostic pathways are not clear in children. Direct DPT by skipping skin tests seems to be an appropriate strategy even for adults with a history considered low risk.…”

Section: Risk Stratification Approaches Based On Clinical Features An...mentioning

confidence: 99%

New diagnostıc perspectives in the management of pediatrıc beta‐lactam allergy

Arıkoğlu

Kuyucu

Caubet

2022

Pediatric Allergy Immunology

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Beta-lactams (BLs) are frequently used as first-line therapy for bacterial infections and are among the most commonly implicated medications in children with allergic drug reactions. The prevalence of BL allergy varies from 1% to 10% in children, depending on prescribing practices and diagnostic protocols. 1 However, it is confirmed in only 6.8%-15.9% of the children with a history of reaction to BLs

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Diagnosis of non-immediate hypersensitivity to amoxicillin in children by skin test and drug provocation tests: A retrospective case-series study

Katoh

Natsume

Matsunaga

et al. 2022

Allergology International

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Direct Oral Provocation Test Is Safe and Effective in Diagnosing Beta-Lactam Allergy in Low-Risk Children With Mild Cutaneous Reactions

Cited by 8 publications

References 27 publications

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

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

New diagnostıc perspectives in the management of pediatrıc beta‐lactam allergy

Diagnosis of non-immediate hypersensitivity to amoxicillin in children by skin test and drug provocation tests: A retrospective case-series study

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