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Skin tests are important in children with β-lactam hypersensitivity, but may be reduced in number

Lucia Diaferio1,2, Anca Mirela Chiriac1,3, Maria Chiara Leoni4

  • 1Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France.

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|February 9, 2019
PubMed

Insights

Skin tests for beta-lactam (BL) allergy in children are effective screening tools. Testing only the suspected drug can be sufficient for allergy workup, reducing patient discomfort.

Area of Science:

  • Pediatric Allergy and Immunology
  • Clinical Pharmacology
  • Drug Hypersensitivity

Background:

  • Standard allergy workup for beta-lactam (BL) hypersensitivity in children lacks consensus.
  • Skin testing (ST) is limited by pain, impacting complete allergy workup.
  • This study aimed to reduce ST numbers in pediatric BL allergy evaluations.

Purpose of the Study:

  • To assess the feasibility of reducing skin tests (ST) in pediatric allergy workup for beta-lactam (BL) hypersensitivity.
  • To determine the positive predictive value (PPV) of ST for BL hypersensitivity.
  • To optimize the diagnostic approach for suspected BL reactions in children.

Main Methods:

  • Retrospective analysis of 319 patients with BL reactions over 16 years to determine ST PPV.
  • Prospective study including 229 children with suspected BL hypersensitivity.
  • Pediatric patients underwent skin testing with the suspected drug only.

Main Results:

  • The retrospective study established a high PPV (99.4%) for ST in identifying BL hypersensitivity.
  • In the prospective study, 5.2% of children (12/229) were diagnosed with BL hypersensitivity.
  • Diagnosis was achieved equally via ST (delayed reading) and drug provocation tests (DPT) in the prospective cohort.

Conclusions:

  • Skin testing (ST) with beta-lactams (BL) is a reliable screening test preceding drug provocation tests (DPT).
  • Testing only the suspected drug via ST may be sufficient for diagnosing BL hypersensitivity in children.
  • This approach can optimize allergy workup and minimize patient discomfort.
Abstract

Keywords:
beta-lactam allergychildrendrug allergyskin tests

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