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Provocation Tests in Nonimmediate Hypersensitivity Reactions to β-Lactam Antibiotics in Children: Are Extended
Rosa García Rodríguez1, Lucia Moreno Lozano1, Alba Extremera Ortega1
1Allergy Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
Insights
Nonimmediate reactions to beta-lactam antibiotics in children can often be diagnosed with a single-day provocation test. Further home observation or re-challenge may be needed if the initial test is negative, aiding in accurate allergy diagnosis.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pharmacology
Background:
- Beta-lactam antibiotics are frequent triggers of hypersensitivity reactions in children, predominantly nonimmediate.
- Confirmed beta-lactam allergy is diagnosed in 7-10% of pediatric cases.
- Standardized provocation testing protocols for nonimmediate reactions are lacking.
Purpose of the Study:
- To evaluate the necessity of repeated beta-lactam doses for eliciting nonimmediate reactions in pediatric patients.
- To establish an effective diagnostic approach for nonimmediate hypersensitivity to beta-lactams in children.
Main Methods:
- Retrospective observational study including children under 14 with suspected nonimmediate reactions to beta-lactams.
- A 1-day hospital provocation test was administered, followed by home observation for a period matching the index reaction's onset.
- If negative, patients underwent an extended home provocation with two daily therapeutic doses.
Main Results:
- Out of 97 patients, 14 (14.4%) showed a positive reaction.
- The initial hospital provocation identified 3 immediate and 8 delayed reactions.
- Subsequent home re-challenge confirmed 1 immediate and 2 delayed reactions.
Conclusions:
- A 1-day provocation test can effectively trigger nonimmediate beta-lactam reactions in children.
- Recommended protocol: 1-day provocation test, followed by observation for the index reaction's time interval.
- Extended home provocation is a viable option for negative initial challenges.
Background:
β-Lactam antibiotics are the most common trigger of reactions in children with most of them being nonimmediate (85.5%), but proven allergy after the allergological workup is between 7% and 10%. There is no agreement on how to perform the provocation tests in these types of hypersensitivity reactions.
Objective:
To determine whether or not repeated doses of the β-lactams are required to reproduce a nonimmediate reaction in children.
Methods:
This is a retrospective observational study. We included children under 14 years who were referred for a nonimmediate reaction to β-lactams. All patients underwent a 1-day hospital provocation and were kept under observation at home during the following days for at least the time elapsed between the first dose and the symptoms of the index reaction. If no reaction was triggered, the patient resumed the provocation at home with 2 daily therapeutic doses for an equal of interval time.
Results:
Ninety-seven patients were included in the study. A positive reaction was recorded in 14 of them (14.4%). The short hospital provocation triggered 3 immediate reactions and 8 delayed reactions. The home rechallenge developed 1 immediate reaction and 2 delayed reactions.
Conclusions:
Nonimmediate reactions to β-lactams in children may be triggered with a 1-day provocation test. We suggest to perform a 1-day provocation test followed by an observational period of at least the time interval of the index reaction. If this challenge is negative, an extended home provocation could subsequently be carried out.
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