Related Experiment Videos
Penicillin allergy--a rare paediatric condition?
V Graff-Lonnevig1, G Hedlin, A Lindfors
1Paediatric Department, Sachs' Children's Hospital, Stockholm, Sweden.
Insights
Many children diagnosed with penicillin allergy tolerate penicillin well. Clinical investigation, not just history, is crucial for accurate penicillin allergy diagnosis in pediatric patients.
Area of Science:
- Allergy and Immunology
- Pediatric Medicine
- Pharmacology
Background:
- Penicillin allergy is frequently diagnosed in children.
- Adverse reactions to penicillin are common concerns in pediatric care.
- Accurate diagnosis of penicillin allergy is essential for appropriate antibiotic selection.
Purpose of the Study:
- To evaluate the actual incidence of penicillin allergy in children with a history of adverse reactions.
- To determine the safety and tolerance of penicillin V re-challenge in this pediatric population.
- To assess the long-term outcomes of children previously labeled as penicillin allergic.
Main Methods:
- Radioallergosorbent test (RAST) for penicillin metabolites.
- Skin prick testing (SPT) with penicillin V.
- Controlled oral penicillin V challenge.
- Long-term follow-up interviews.
Main Results:
- No severe reactions occurred during oral penicillin challenge.
- Slight to moderate skin reactions were observed in 10% of subjects.
- 94% of children tolerated subsequent penicillin treatment well, with no adverse reactions reported during follow-up.
Conclusions:
- The diagnosis of penicillin allergy is often overused in children.
- Clinical evaluation, including objective testing and challenge, is necessary to confirm penicillin allergy.
- Many children presumed to be penicillin allergic can safely receive penicillin medications.
Abstract:
A total of 298 children with a history of adverse reactions in connection with oral penicillin treatment were investigated with a radioallergosorbent test for penicillin metabolites, the skin prick test, and oral challenge with penicillin V. No severe reactions were seen. In 30 (10%) of the subjects slight to moderate skin reactions were observed on the seventh to 10th day of the challenge period. Between one to four years after the oral challenge 222 children were reinvestigated by interview. One hundred and ten had been given treatment by penicillin and 103 (94%) of these children tolerated the new treatment well and without any adverse reactions. We conclude that the term 'penicillin allergy' is often misused. Such a diagnosis should be established by clinical investigation.