Short protocol for the study of paediatric patients with suspected betalactam antibiotic hypersensitivity and low risk criteria

Moral, Luis; Garde, J.; Toral, Teresa; Fuentes, María Jesús; Marco, Nuria

doi:10.1016/j.aller.2010.10.002

Cited by 36 publications

(28 citation statements)

References 12 publications

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“…Skin prick and ID tests were performed to this patient after positive OPT and were negative. A second OPT was also performed, and the same reaction occurred again confirming the diagnosis .…”

Section: Discussionmentioning

confidence: 65%

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Direct oral provocation tests in non‐immediate mild cutaneous reactions related to beta‐lactam antibiotics

Vezir

Mısırlıoğlu

Civelek

et al. 2015

Pediatric Allergy Immunology

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Section: Discussionmentioning

confidence: 65%

“…Also these tests are difficult to perform, time-consuming, and cause pain in children. Because of these disadvantages, some studies inves- (25). Oral provocation tests are the gold standard for the diagnosis of non-immediate beta-lactam hypersensitivity (6,10).…”

Section: Discussionmentioning

confidence: 99%

Direct oral provocation tests in non‐immediate mild cutaneous reactions related to beta‐lactam antibiotics

Vezir

Mısırlıoğlu

Civelek

et al. 2015

Pediatric Allergy Immunology

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“…Considering that most children (more than 90%) are not confirmed as allergic, this algorithm is heavily resource‐intensive and time‐consuming or could even lead to a number of wrong diagnoses of drug hypersensitivity due to uncertain predictive values of skin tests. In recent years, a number of papers have challenged the academic guidelines and have explored the feasibility of performing OPT without skin tests in children with suspicion of a benign non‐immediate reaction . In spite of reported good results, economic savings, and observed satisfaction by parents and doctors, this attitude is still debated and some authors still consider performing intradermal tests, mainly due to fear of severe reactions during OPT .…”

Section: What To Do With a Child With Suspected Blh In A Specialized mentioning

confidence: 99%

“…In recent years, a number of papers have challenged the academic guidelines and have explored the feasibility of performing OPT without skin tests in children with suspicion of a benign non-immediate reaction. 4,[6][7][8][9] In spite of reported good results, economic savings, and observed satisfaction by parents and doctors, this attitude is still debated and some authors still consider performing intradermal tests, mainly due to fear of severe reactions during OPT. 10 As a result, in current clinical practice, things are not so clear and very different approaches are followed by practicing clinicians.…”

Section: What To Do With a Child With Suspected Blh In A Specializementioning

confidence: 99%

Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

Moral

Caubet

2017

Pediatric Allergy Immunology

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Suspected allergy to penicillins and cephalosporins is very common in childhood. After a proper evaluation, allergy will be confirmed only in a small portion of them. Intradermal tests are usually part of the allergy workup, but they are painful for children and time-consuming, and their role has been debated. A systematic review found only two studies reporting a positive predictive value of skin tests in children of 36% and 33%, respectively, leading to a high rate of inaccurate diagnosis. Moreover, considering that skin tests are negative in more than 90%-95% of cases, an oral provocation test (OPT) is finally needed to confirm tolerance in most of these children. Positive OPT are rare, and even where children demonstrate reproducible signs on challenge, they rarely constitute immediate or serious symptoms. Therefore, OPT to the index antibiotic without skin tests are increasingly being considered an accepted procedure for children with a suspected mild non-immediate reaction related to a beta-lactam antibiotic. Furthermore, a recent research has taken the same approach including children with suspected mild immediate reactions, with similar safety and positive results. In light of recent evidence highlighted, it is now the time for large and multicentric studies to confirm that OPT with the index antibiotic, without skin tests, are safe and convenient for children with a history of a mild reaction with a beta-lactam antibiotic before it can be recommended in pediatric allergy guidelines.

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“…Particularly, intradermal tests (IDTs), which are more sensitive than prick tests, are painful and can be poorly tolerated by small children. Thus, for nonimmediate reactions, such as mild exanthemas, it has been proposed to perform drug provocation tests (DPT) without prior skin tests .…”

mentioning

confidence: 99%

Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group

Gomes

Brockow

Kuyucu

et al. 2015

Allergy

236

336

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When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sicknesslike reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.

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Short protocol for the study of paediatric patients with suspected betalactam antibiotic hypersensitivity and low risk criteria

Abstract: Direct oral provocation in low risk patients has been shown to be effective and safe in discarding hypersensitivity to betalactam antibiotics in the majority of the patients studied.

Cited by 36 publications

References 12 publications

Direct oral provocation tests in non‐immediate mild cutaneous reactions related to beta‐lactam antibiotics

Direct oral provocation tests in non‐immediate mild cutaneous reactions related to beta‐lactam antibiotics

Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group

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