Allergy to beta-lactam antibiotics in children: predictors for a positive oral challenge test

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Pharmacology
• Infectious Diseases

Background:

• Beta-lactam antibiotic allergies are frequently reported in children, affecting 5%-10%.
• However, a significant majority (up to 90%) do not exhibit reactions during oral challenge testing (OCT).
• This highlights a potential overdiagnosis of beta-lactam allergy in pediatric populations.

Purpose of the Study:

• To determine the actual frequency of positive in-hospital graded beta-lactam oral challenge tests (OCTs) in children with a beta-lactam antibiotic allergy label (AAL).
• To identify specific predictors associated with positive OCT outcomes in this pediatric cohort.

Main Methods:

• A retrospective study analyzed data from 1259 children (aged 0-19 years) who underwent beta-lactam OCT over 7 years.
• The OCT protocol involved an in-hospital graded challenge followed by a 5-day outpatient antibiotic course.
• Univariate and multivariate logistic regression analyses were employed to identify predictors of positive in-hospital graded OCTs.

Main Results:

• Only 1.4% (18/1259) of in-hospital graded OCTs were positive, with 0.8% (10/1259) being equivocal.
• A mere 0.3% (4/1259) of children experienced immediate, severe reactions during the in-hospital graded OCT.
• Predictors for positive OCT included a history of other drug allergies (OR 2.7), severe index reactions (OR 2.9), immediate and severe index reactions (OR 5.85), and reactions requiring epinephrine (OR 9.65).

Conclusions:

• The study confirms a low frequency (1.4%) of positive in-hospital graded OCTs among children with a beta-lactam AAL.
• Key risk factors for positive OCTs in children include a history of other drug allergies and the severity of the initial reaction, particularly if immediate, severe, or requiring epinephrine.