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Anaphylaxis to beta-lactam antibiotics at pediatric age: Six-year survey

J Azevedo1, Â Gaspar2, I Mota2

  • 1Immunoallergy Department, Coimbra Hospital Universitary Centre, Coimbra, Portugal.

Allergologia Et Immunopathologia
|September 26, 2018
PubMed

Insights

Beta-lactam hypersensitivity reactions in children are rare but serious. A thorough allergy work-up is crucial for accurate diagnosis and safe alternative antibiotic selection.

Area of Science:

  • Pediatric Allergy and Immunology
  • Clinical Pharmacology
  • Drug Hypersensitivity

Background:

  • Beta-lactam antibiotics are widely used in children.
  • Anaphylactic reactions to beta-lactams can occur but are understudied in pediatric populations.
  • Limited research exists on the prevalence and characteristics of beta-lactam hypersensitivity in children.

Purpose of the Study:

  • To characterize case reports of anaphylaxis in children with suspected beta-lactam hypersensitivity.
  • To analyze the diagnostic work-up and outcomes for pediatric patients referred to a drug allergy center.
  • To identify the incidence and clinical features of confirmed beta-lactam hypersensitivity and anaphylaxis in children.

Main Methods:

  • Retrospective analysis of pediatric patients (January 2011-December 2016) with suspected beta-lactam hypersensitivity.
  • Standardized drug allergy work-up including specific IgE, skin prick tests, intradermal tests, and drug challenges.
  • Evaluation of diagnostic procedures according to ENDA/EAACI guidelines.

Main Results:

  • 146 children were studied; 21 (14.4%) had confirmed hypersensitivity.
  • Seven children (33.3% of confirmed cases) experienced anaphylaxis, primarily with cutaneous and respiratory/gastrointestinal symptoms.
  • Amoxicillin and flucloxacillin were the most frequent culprits; most anaphylaxis cases were IgE-mediated, with positive skin tests despite negative specific IgE.
  • Oral challenge with cefuroxime was negative in all tested cases.

Conclusions:

  • Beta-lactam allergic reactions, though infrequent in children, necessitate detailed clinical assessment and specialized drug allergy evaluation.
  • Accurate diagnosis is vital to prevent potentially life-threatening reactions and guide the selection of alternative antibiotics.
  • A comprehensive diagnostic approach ensures patient safety and optimizes therapeutic options.
Abstract

Keywords:
AnaphylaxisBeta-lactamsChildrenDrug allergy

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