RT Journal Article
SR Electronic
T1 Mild to moderate hypersensitivity reactions to beta-lactams in children: a single-centre retrospective review
JF BMJ Paediatrics Open
JO BMJ Paediatrics Open
FD BMJ Publishing Group Ltd
SP e000435
DO 10.1136/bmjpo-2019-000435
VO 3
IS 1
A1 Leticia Vila
A1 Vanesa Garcia
A1 Oihana Martinez Azcona
A1 Loreley Pineiro
A1 Angela Meijide
A1 Vanesa Balboa
YR 2019
UL http://bmjpaedsopen.bmj.com/content/3/1/e000435.abstract
AB Objective Beta-lactam (BL) antibiotics are the most reported drugs in hypersensitivity reactions in children. More than 90% of these children tolerate the suspected drug after diagnostic work-up. Skin tests (STs) show low sensitivity. Our aim was to assess the performance of drug provocation tests (DPTs) without previous ST in mild and moderate delayed reactions and to propose a new DPT protocol.Design of the study Charts from 213 children under 15 years of age referred for suspected BL allergy from 2011 to 1013 were reviewed. Prick, intradermal and patch tests were performed with major determinant penicilloyl-polylysine, minor determinant mixture, amoxicillin (AMX), cefuroxime, penicillin G and AMX–clavulamate. Children with negative skin tests underwent DPT. After an initial full dose of antibiotic, DPT was carried on for 3 days at home in patients reacting within the first 3 days of treatment. If the reaction took place from day 4 on of treatment, patients took the antibiotic for 5 days.Results We included 108 girls and 105 boys. Mean age at the time of reaction was 3.66±3.06 years. 195 patients (91.5%) reacted to one BL. 154 reactions (67.2%) were non-immediate. Mild to moderate skin manifestations were most frequently reported. AMX–clavulanate was the most frequently involved (63.4%). DPT confirmed the diagnosis of drug hypersensitivity in 17 (7.3%) cases. These 17 patients had negative ST.Conclusion In mild and moderate cases of BL hypersensitivity, diagnosis can be performed by DPT without previous ST