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Drug provocation tests to betalactam antibiotics: experience in a paediatric setting
M Chambel1, P Martins, I Silva
1Immunoallergy Department, Dona Estefânia Hospital, Lisbon Central Hospital, Portugal. chambel.marta@gmail.com
Insights
The drug provocation test (DPT) is a safe and practical method for diagnosing betalactam antibiotic allergies in children, even without prior skin testing. Asthma and food allergies may be associated with positive DPT results.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pharmacology
Background:
- Limited research exists on betalactam allergy diagnosis in pediatric populations.
- Betalactam antibiotics are common causes of reported hypersensitivity reactions in children.
Purpose of the Study:
- To evaluate the utility and safety of drug provocation testing (DPT) for betalactam hypersensitivity in children.
- To investigate the association between betalactam allergy and other allergic conditions in pediatric patients.
Main Methods:
- A prospective study of 161 children under 15 years with suspected betalactam allergy.
- Children underwent DPT, with skin testing (ST) performed optionally prior to DPT.
- DPT was administered with the suspected culprit betalactam antibiotic.
Main Results:
- Out of 161 children, 20.5% experienced immediate and 20.5% non-immediate reactions, mostly of low severity.
- DPT was positive in 3.4% of skin-tested children and 13.4% of those not skin-tested.
- Asthma and food allergy were linked to positive DPT outcomes in children not initially skin-tested.
Conclusions:
- DPT is a safe diagnostic procedure for pediatric betalactam hypersensitivity, particularly when skin tests are not feasible.
- DPT offers a practical approach for diagnosing betalactam allergy in infants and young children.
- Children with co-existing asthma or food allergies require careful consideration during DPT evaluation.
Background:
Few studies have been performed in children with suspected betalactam allergy. We aimed to assess the role of the drug provocation test (DPT) with betalactams in a paediatric setting and to study the association between allergy to betalactam antibiotics and other allergic diseases.
Methods:
We included all the patients under 15 years old who were consecutively referred to the Immunoallergy Department, Dona Estefânia Hospital, Portugal (January 2002 to April 2008) for a compatible history of allergic reaction to betalactam. All were submitted to a DPT. Children were proposed to perform skin tests (ST) to betalactam antibiotics followed by DPT. If they decline ST, a DPT with the culprit drug was performed.
Results:
We studied 161 children, 60% were boys, with a median age of 5 years old at the time of the DPT. Thirty-three patients (20.5%) had an immediate reaction and 33 (20.5%) a non-immediate reaction. The severity of the reported reactions was low in most cases. Skin tests to betalactams were performed in 47 children and were positive in 8. DPT was positive in only one (3.4%) of the patients skin tested and in 11 (13.4%) of those not skin tested. The severity of the DPT reaction was low. Asthma and food allergy were associated with a positive DPT in the later group.
Conclusions:
DPT seems a safe procedure even in the absence of ST in non-severe cases. This could be a practical option in infants and pre-school children, where ST are painful and difficult to perform. Additional caution should be taken in children with asthma and food allergy.
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