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Prospective assessment of diagnostic tests for pediatric penicillin allergy: From clinical history to challenge tests

María Dolores Ibáñez1, Pablo Rodríguez Del Río1, Eva Maria Lasa2

  • 1Allergy Department, Niño Jesús University Children's Hospital, Madrid, Spain; The Research Network ARADyAL RD16/0006/0026.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|May 28, 2018
PubMed

Insights

Penicillin allergy testing in children can be simplified. Drug provocation tests are accurate for diagnosing non-severe penicillin allergies in children, even when other tests are negative.

Area of Science:

  • Pediatric Allergy and Immunology
  • Clinical Diagnostics
  • Pharmacovigilance

Background:

  • Current penicillin allergy diagnostic guidelines for children are complex and may not be optimal.
  • Existing protocols are often based on adult data, necessitating pediatric-specific research.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of various tools for identifying penicillin allergy in pediatric populations.
  • To assess the reliability of clinical history, skin tests, and serum specific IgE (sIgE) compared to drug provocation tests (DPTs).

Main Methods:

  • A prospective, multicenter study involved 732 children with reported non-severe penicillin adverse events.
  • A comprehensive diagnostic protocol included clinical history, skin tests, sIgE, and DPTs for all participants.
  • Amoxicillin was the primary drug used for provocation testing.

Main Results:

  • Penicillin allergy was confirmed in 4.8% of children, with 83% presenting as nonimmediate reactions.
  • Drug provocation tests (DPTs) confirmed allergy in 35 children, with no severe reactions observed.
  • Skin tests and sIgE results were negative in 91% of children ultimately diagnosed with penicillin allergy.

Conclusions:

  • Conventional allergy predictors showed limited accuracy in this pediatric cohort.
  • The study supports the use of straightforward drug provocation testing in experienced centers for diagnosing non-severe penicillin allergy in children.
  • This approach offers a more reliable method for pediatric penicillin allergy diagnosis.
Abstract

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