ABSTRACT
OBJECTIVE: To evaluate the use of a questionnaire-based decision-making algorithm to triage children with reported antibiotic allergies to proceed directly to an oral provocation challenge. DESIGN: Cohort study. SETTING: Children aged 2-16 years attending paediatric emergency department over 1 year (1 June 2018 till 31 May 2019) or identified from four primary care centres in Sheffield with a recorded antibiotic allergy and no previous testing. PARTICIPANTS: 313 children with 325 recorded antibiotic allergies. EXPOSURE: Clinical decision-making algorithm used to either exclude, directly delabel or stratify children to oral antibiotic challenge in outpatient department or primary care practice. MAIN OUTCOME MEASURES: To assess the safety of using the questionnaire-based algorithm for proceeding to a direct oral provocation challenge.The secondary outcomes were to look for associations and predictive factors in positive challenges and to assess parent/carer acceptability of the service by using Likert Scale. RESULTS: Successful contact was made with 200 children, of which 153 children could be evaluated based on inclusion criteria, engagement and availability of medical records.15 children were directly delabelled based on history and records. 138 children underwent challenges in outpatient and primary care. 6% of challenges were reactive with a mild, delayed reaction. Overall, a delabelling rate of 91% was achieved. There were no clear predictors for a positive challenge. CONCLUSION: Our questionnaire-based algorithm for stratifying children with antibiotic allergies to proceed directly to an oral outpatient or primary care challenge was found to be safe, feasible and acceptable.
ABSTRACT
While the myriad manifestations of Kawasaki disease are increasingly being recognized, there are still many instances where this diagnosis can come as a surprise to the clinician. The authors report one such child who appeared to have acute infective hepatitis at presentation but went on to develop the full clinical picture of Kawasaki disease. This is a rarely reported presentation of Kawasaki disease.
Subject(s)
Jaundice/diagnosis , Mucocutaneous Lymph Node Syndrome/diagnosis , Child , Diagnosis, Differential , Humans , MaleABSTRACT
OBJECTIVES: To compare vaccine related reactogenicity during primary immunization in healthy infants using 23 vs. 25 gauge needles. METHODS: This randomized controlled trial was conducted in Vaccination Room of the Advanced Pediatrics Center. 155 participants for primary immunization were assigned to two intervention groups (23 vs. 25 gauge). Parent-reported local and systemic reactions were recorded daily for three days after the immunization. RESULTS: Swelling (24%) and tenderness (21%) were the two most common parent-reported local symptoms followed by restriction of movements (18%) and redness (10%) on day 1. Any local reaction on day 1 was statistically similar in 25 gauge vs. 23 gauge group (RR 0.77; 95% CI: 0.32 to 1.82) (P = 0.54), but fever (day 1) showed higher trend in 23 gauge needle group (RR 2.24; 95% CI: 0.92-5.47) (P = 0.07). Furthermore, on analysis of serially reported local and systemic reactions for 3 consecutive days by generalized estimating equations, odds of redness, swelling, tenderness, restricted movement and fever were statistically similar between two needle groups. On the other hand, median (± SE) crying time (in seconds) was significantly prolonged in the 25 gauge needle (39 ± 2) as compared to 23 gauge group (30 ± 1.3) (log rank test, P = 0.001). CONCLUSIONS: The use of same length needles with narrower (25) or wider (23) gauge did not show significant differences in local reactogenicity during primary immunization. Fever, however, was reduced marginally in 25 gauge group whereas crying duration was significantly shorter with 23 gauge needle. Finally, larger studies are needed to further evaluate objectively the outcome of reactogenicity.
