An EAACI Task Force report on allergy to beta-lactams in children: Clinical entities and diagnostic procedures.

Beta-lactam (BL) allergy suspicion is common in children and constitutes a major public health problem, with an impact on patient's health and on medical costs. However, it has been found that most of these reactions are not confirmed by a complete allergic workup. The diagnostic value of the currently available allergy tests has been investigated intensively recently by different groups throughout the world. This has led to major changes in the management of children with a suspected BL allergy. Particularly, it is now well accepted that skin tests can be skipped before the drug provocation test in children with a benign non-immediate reaction to BL. However, there is still a debate on the optimal allergic workup to perform in children with a benign immediate reaction. In addition, management of children with severe cutaneous adverse drug reactions remains difficult. In this review, based on a selection of the most relevant studies found in the literature, we will review and discuss the diagnosis of different forms of BL allergy in children.

Delayed hypersensitivity to antiepileptic drugs in children.

BACKGROUND: Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life-threatening. AIM: This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature. RESULTS: Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids. CONCLUSION: Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. There is therefore an ongoing need to improve our knowledge of HS reactions due to AED medications and in particular to improve our diagnostic capabilities.

Patients' satisfaction with diagnostic drug provocation tests and perception of its usefulness.

BACKGROUND AND AIM: Although still controversial, drug provocation tests (DPTs) are considered by many as the gold standard for diagnosis of drug hypersensitivity. No studies have addressed the opinion of patients submitted to DPT. We aimed to determine patient satisfaction with diagnostic DPT and their perception of its usefulness. METHODS: Surveys were supplied to patients submitted to diagnostic DPT in 3 different drug allergy clinics which used the same diagnostic protocols for drug hypersensitivity evaluation. Seventy-three patients (33.6%) were enrolled in Porto (Portugal), 102 (47%) in Montpellier (France) and 42 (19.4%) in Vilnius (Lithuania). The patients filled in a written questionnaire within 15 days after the diagnostic procedure, and satisfaction was assessed on a 1 (very unsatisfied) to 5 (very satisfied) score. RESULTS: A total of 217 surveys were collected; 144 female patients (66.4%). The most prevalent studied reactions were cutaneous (70.1%), but 17.9% of the patients had had a systemic reaction. ß-Lactam antibiotics were the main culprit drugs (44.3%) tested in all centres and 25.3% of the patients had a positive DPT. No patients were unsatisfied (8.8% were neither unsatisfied nor satisfied and the others were satisfied or very satisfied). The level of satisfaction did not depend on the results of the DPT; 207 (95.4%) believed DPTs were useful and almost all the patients would recommend DPTs to others. CONCLUSIONS: Most patients were satisfied with DPT for diagnostic purposes. Satisfaction with the procedure was independent of the results of the provocation tests and did not depend on the country.