Drug Provocation Tests for Assessing Antibiotic Hypersensitivity

Abstract

Background: Suspected antibiotic hypersensitivity in children is a frequent reason for consultation. Skin test performance and drug provocation test (DPT) duration are controversial issues. The objective of this study was to assess the effectiveness of diagnostic tests used in the study of antibiotic hypersensitivity and to estimate an optimal duration for DPT. Methods: Sixty-two children with a suspected hypersensitivity reaction to antibiotics were studied. Skin tests were performed on all patients. In the case of negative results, DPTs were performed for a duration similar to the time elapsed from the start of treatment until the onset of the reaction. Results: The frequency of antibiotic hypersensitivity in the study population was 8.1% (5 of 62). Only 1 patient showed positive skin tests. The other allergic patients were diagnosed by DPT, which reproduced the reaction within the first 6 hours in all but one of them. Conclusions: Shortening DPT duration may decrease the sensitivity of the test for the diagnosis of non–IgE-mediated hypersensitivity; however, it should be considered as an opportunity to reduce the resulting microbial resistances.

Advances in immunoglobulin E mediated antibiotic allergy

“…To rule out IgE mediated hypersensitivity, a single dose challenge is sufficient. Recent data suggests that one or two-step challenges are adequate for delabeling low risk delayed reactions, although, multiple day challenge courses may be considered in select cases and particularly where reintroduction is a strategy or chronic therapy is required [57]. In a study of 62 children with beta-lactam allergy, 5 (8.1%) were determined to be allergic, 1 based on skin testing, 1 developed urticaria seven days into course, 2 with maculopapular eruption 4–6 h after challenge, and 1 with urticaria and angioedema 2.5 h after challenge [57].…”

“…Recent data suggests that one or two-step challenges are adequate for delabeling low risk delayed reactions, although, multiple day challenge courses may be considered in select cases and particularly where reintroduction is a strategy or chronic therapy is required [57]. In a study of 62 children with beta-lactam allergy, 5 (8.1%) were determined to be allergic, 1 based on skin testing, 1 developed urticaria seven days into course, 2 with maculopapular eruption 4–6 h after challenge, and 1 with urticaria and angioedema 2.5 h after challenge [57]. When determining the length of challenge, it is critical to consider development of drug resistant organisms, the low yield in confirmation of drug hypersensitivity, and balance this with the possibility of treating a rare, nonsevere rash.…”