Oral Challenge without Penicillin Skin Tests in Children with Suspected Beta-Lactam Hypersensitivity

IF 0.3 Q4 PEDIATRICS Journal of Child Science Pub Date : 2022-09-29 DOI:10.1055/s-0042-1757151
G. Atakul, S. Köse, O. Atay, O. Boyacıoglu, S. Al, S. Asilsoy, N. Uzuner, O. Karaman
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引用次数: 2

Abstract

Objective A misdiagnosed “penicillin allergy” is a common problem in childhood. Recently, skipping skin tests (STs) and performing a direct oral challenge test (OCT) have become an increasingly common approach in children with suspected β-lactam (BL) allergy. In our study, we aimed to evaluate the safety and efficacy of OCT without using ST in children who had a history of hypersensitivity reactions with BL antibiotics. Materials and Methods We retrospectively evaluated direct OCT outcomes in children with both nonimmediate and immediate-type reaction history with BL antibiotics. STs were not performed before the challenge test. The patients were monitored for 4 hours after the challenge and continued using the drug in two divided doses for 3 days at home. Results In this study, 72 patients were included, with median age of 7 years (interquartile range: 4; min: 1 year to max: 16 years), and of these, 56% were male. Forty-five subjects (63%) reported immediate-type adverse reactions. The most common clinical manifestation was urticaria/angioedema (51%, n: 37) and maculopapular exanthema in 46% (n: 33) of patients, respectively. The most commonly suspected drug was 71% amoxicillin-clavulanate. A 3-day OCT without preceding ST was performed in all patients. Only three patients (4.2%) showed a positive response to the oral drug challenge test. None of these reactions observed was more severe than index reactions. Conclusion Performing OCT without STs is a safe and convenient method to exclude BL hypersensitivity in the pediatric age group.
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怀疑β -内酰胺过敏儿童无青霉素皮肤试验的口服刺激
客观的 误诊为“青霉素过敏”是儿童时期的常见问题。最近,在疑似β-内酰胺(BL)过敏的儿童中,跳过皮肤试验(ST)和进行直接口腔激发试验(OCT)已成为一种越来越常见的方法。在我们的研究中,我们旨在评估有BL抗生素超敏反应史的儿童在不使用ST的情况下使用OCT的安全性和有效性。材料和方法 我们回顾性评估了有BL抗生素非即时型和即时型反应史的儿童的直接OCT结果。激发试验前未进行ST。对患者进行了4次监测 激发后数小时,并在家中分两次连续使用该药物3天。后果 在这项研究中,纳入了72名患者,中位年龄为7岁(四分位间距:4;最小值:1岁至最大值:16岁),其中56%为男性。45名受试者(63%)报告了即时型不良反应。最常见的临床表现是荨麻疹/血管性水肿(51%,n:37)和斑丘疹(46%,n:33)。最常见的可疑药物是71%的阿莫西林克拉维酸。所有患者均进行了3天OCT检查,无ST段病史。只有三名患者(4.2%)对口服药物激发试验表现出阳性反应。观察到的这些反应中没有一个比指数反应更严重。结论 在没有ST的情况下进行OCT是一种安全方便的方法,可以排除儿童年龄组的BL超敏反应。
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19
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