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Published on: February 23, 2014
Beta-lactam hypersensitivity in children: Frequency and risk factors
Haifa Ben Romdhane1, Nadia Ben Fredj1, Najah Ben Fadhel1
1Department of Pharmacology, EPS Fattouma Bourguiba, Faculty of Medicine, University of Monastir, Tunisia.
Insights
Authentic beta-lactam (BL) hypersensitivity (HS) occurs in 6.7% of children. Older age and specific BLs administered are key predictors of BL hypersensitivity in pediatric patients.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pharmacology
- Immunology
Background:
- Beta-lactam (BL) antibiotics are widely prescribed, but hypersensitivity (HS) reactions are a concern.
- Accurate diagnosis of BL hypersensitivity is crucial to avoid unnecessary avoidance of essential medications.
- Identifying predictive factors for BL hypersensitivity can aid in risk stratification and management.
Purpose of the Study:
- To determine the frequency of authentic beta-lactam (BL) hypersensitivity (HS) in a large pediatric cohort.
- To identify clinical risk factors that predict the development of BL hypersensitivity in children.
Main Methods:
- Children with suspected BL allergy underwent skin testing (ST) and, if negative, a 1-day oral provocation test (OPT).
- Authentic BL-HS was defined by positive ST or OPT results.
- Univariate and multivariate logistic regression analyses were used to identify independent predictors of BL-HS.
Main Results:
- Out of 354 patients, 24 (6.7%) were diagnosed with authentic BL-HS, all confirmed by positive ST.
- Oral provocation tests were negative in all 30 children who underwent them.
- Older age (>5 years) at reaction onset (OR=1.11) and the specific BL administered (OR=7.7) were significantly associated with authentic BL-HS.
Conclusions:
- Beta-lactam hypersensitivity requires thorough allergy work-up before strict avoidance.
- Patient age and the specific beta-lactam involved are valuable predictive factors for BL hypersensitivity in children.
- These findings can guide clinical decisions and improve the management of suspected BL allergies in pediatric populations.
Aims:
To determine the frequency of an authentic β-lactam (BL) hypersensitivity (HS) amongst a large number of children and to identify clinical risk factors that predict this hypersensitivity.
Methods:
All children with suspected BL allergy were evaluated by skin tests (ST) with the suspected BL. A 1-day oral provocation test (OPT) was performed in children with negative ST. We defined an authentic BL-HS case if the child exhibited a positive ST or a positive OPT. Risk factors associated with BL-HS were assessed using a univariate analysis. Covariates showing a P-value <.2 were included in the multivariate logistic regression analysis to determine independent predictors.
Results:
A total of 354 patients reporting 368 suspected BL reactions were included. The diagnosis of BL-HS was established in 24 children (6.7%). All these children had a positive ST. OPT was performed in 30 patients and was negative in all of them. In 110 children with a negative ST, BL was tolerated. In the risk factors analysis, 164 children were included. Older age (>5 years) at the reaction (odds ratio = 1.11; 95% confidence interval, 1.01-1.22; P = .02) and BL administered (odds ratio = 7.7; 95% confidence interval, 2.76-21.8; P < .001) were significantly associated with authentic BL-HS.
Conclusion:
BL-HS should be evaluated with an appropriate allergy work-up before strict prohibition is made. In addition, age of patient and BL involved can be used as predictive factors of developing BL-HS in this population.
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