β-Lactam Allergy in Children

β-lactam antibiotic allergy is the most common drug allergy in children. Most of the patients with suspected reactions to β-lactam antibiotics can actually tolerate these drugs. The aim of this study is to evaluate clinical and laboratory characteristics of children with β-lactam allergy and to determine cross-reactivity between penicillin and cephalosporins.

The diagnosis of β-lactam allergy was made based on the results of skin tests and/or drug provocation tests (DPT). Penicillin allergy skin tests were performed with DAP penicillin® (Diater laboratories, Madrid, Spain), penicillin G, and ampicillin/amoxicillin preparations. Skin and provocation tests were performed with the culprit cephalosporin in addition to the penicillin skin and/or provocation tests to evaluate cephalosporin allergy.

We found that 87.7% (71/81) of patients with β-lactam allergy were able to tolerate the culprit drug. Among ten patients with confirmed diagnosis, two had cross-reactivity (penicillin and cephalosporin) and 8 had a various β-lactam (aminopenicillin n=6, ceftriaxone n=2) allergies. We identified older age and early-type clinical reactions as risk factors for a confirmed β-lactam allergy.

Skin tests and DPT appear to be useful procedures in the diagnosis, and determination of an alternative safe antibiotic in patients with β-lactam allergy. Most of the patients tolerated the drugs. A minority of the patients with confirmed allergy should avoid all β-lactam antibiotics due to the probability of cross-reactivity.