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

IF 4.3 3区医学 Q1 PEDIATRICS Archives of Disease in Childhood Pub Date : 2024-12-13 DOI:10.1136/archdischild-2024-327036

Amanda L Wilkins, Laure F Pittet, Sophie Kyriakou, Kimberly Walker, Susan Donath, Sharon Choo, Noel Cranswick, Amanda Gwee

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Abstract

Objective: Beta-lactam antibiotic allergies are reported in 5%-10% of children; however, up to 90% do not have any reaction at oral challenge test (OCT). This study aimed to determine the frequency and identify predictors of positive in-hospital graded beta-lactam OCTs in children with a beta-lactam antibiotic allergy label (AAL).

Design: This is a retrospective study conducted over 7 years, including children aged 0-19 years who underwent a beta-lactam OCT. The OCT comprised an in-hospital graded challenge followed by a 5-day outpatient antibiotic course. Univariate and multivariate logistic regression analyses were performed to identify predictors of a positive in-hospital graded OCT.

Results: Overall, 1259 beta-lactam OCTs were included: median age at time of OCT was 6.3 years (range 8.8 months to 19.2 years). Of these, 18 (1.4%) in-hospital graded OCTs were positive and 10 (0.8%) were equivocal, with only 4 children (0.3%) having an immediate, severe reaction to their in-hospital graded OCT. Factors associated with a positive in-hospital graded OCT on univariate analysis were: history of other drug allergy (OR 2.7, 95% CI 1.0 to 7.2; p 0.05), an index reaction which was severe (OR 2.9, 95% CI 1.1 to 7.6; p 0.035), immediate and severe (OR 5.85, 95% CI 1.7 to 20.0; p 0.005) or that required epinephrine (OR 9.65, 95% CI 1.7 to 53.6; p 0.01).

Conclusion: Of the children referred with a beta-lactam AAL, only 1.4% had a positive in-hospital graded OCT. Risk factors for a positive in-hospital graded OCT were history of other drug allergy, an index reaction which was severe, immediate and severe or required epinephrine.

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儿童对β-内酰胺类抗生素过敏：口服挑战测试呈阳性的预测因素。

目的：据报道，5%-10%的儿童对β-内酰胺类抗生素过敏；然而，高达 90% 的儿童在口腔挑战试验（OCT）中未出现任何反应。本研究旨在确定β-内酰胺类抗生素过敏标签（AAL）儿童院内分级β-内酰胺类抗生素OCT阳性反应的频率和预测因素：这是一项历时 7 年的回顾性研究，研究对象包括接受过β-内酰胺类药物 OCT 检查的 0-19 岁儿童。OCT包括院内分级挑战和为期5天的门诊抗生素疗程。我们进行了单变量和多变量逻辑回归分析，以确定院内分级 OCT 阳性的预测因素：总共纳入了 1259 例β-内酰胺类 OCT：OCT 时的中位年龄为 6.3 岁（范围为 8.8 个月至 19.2 岁）。其中，18例（1.4%）院内分级OCT为阳性，10例（0.8%）为模棱两可，只有4名儿童（0.3%）对其院内分级OCT立即产生了严重反应。在单变量分析中，与院内分级 OCT 阳性相关的因素有：其他药物过敏史（OR 2.7，95% CI 1.0 至 7.2；P 0.05）、指数反应严重（OR 2.9，95% CI 1.1 至 7.6；P 0.035）、立即且严重（OR 5.85，95% CI 1.7 至 20.0；P 0.005）或需要肾上腺素（OR 9.65，95% CI 1.7 至 53.6；P 0.01）：结论：在使用β-内酰胺类 AAL 的转诊患儿中，只有 1.4% 的患儿院内分级 OCT 呈阳性。出现院内分级 OCT 阳性的风险因素包括：有其他药物过敏史、出现严重、即时和严重或需要肾上腺素的指数反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Disease in Childhood 医学-小儿科

CiteScore

5.80

自引率

3.80%

发文量

291

审稿时长

3-6 weeks

期刊介绍： Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.