Approach for delabeling beta-lactam allergy in children.

A considerable number of pediatric patients treated with beta-lactam (BL) antibiotics develop delayed onset of skin rashes during the course of treatment. Although the most frequent cause of these symptoms is infectious, many cases are labeled as allergic reactions to these drugs. BL allergy labels could have a negative impact, as they imply avoidance of this group of drugs and the use of second-line antibiotics, leading to a potential increase in adverse effects and the utilization of less effective therapies. This constitutes a major public health concern and economic burden, as the use of broad-spectrum antibiotics can result in multidrug-resistant organisms and prolonged hospital stays. Therefore, it is crucial to delabel patients during childhood to avoid false labeling in adult life. Although the label of BL allergy is among the most frequent causes of allergy referral, its management remains controversial, and new diagnostic perspectives are changing the paradigm of managing BL allergies in children. Traditionally, drug provocation testing (DPT) was exclusively performed in patients who had previously obtained negative results from skin tests (STs). However, the sensitivity of STs is low, and the role of in vitro testing in the pediatric population is not well defined. Recent studies have demonstrated the safety of direct DPT without prior ST or serum tests for pediatric patients who report a low-risk reaction to BLs, which is cost-effective. However, there is still a debate on the optimal allergic workup to be performed in children with a benign immediate reaction and the management of children with severe cutaneous adverse drug reactions. In this review, we will discuss the impact of the label of BL allergy and the role of the different tools currently available to efficiently address BL allergy delabeling in children.

Corrigendum: Approach for delabeling beta-lactam allergy in children.

[This corrects the article DOI: 10.3389/falgy.2023.1298335.].

Tratamiento con valproato y esteatosis hepática / Treatment with valproate and hepatic steatosis

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Late-onset isolated gelastic epilepsy secondary to entrapment of the right temporal horn.

The case is reported of a 70 year-old woman with isolated gelastic seizures (GS) secondary to a rare form of focal obstructive hydrocephalus, called entrapment of the lateral horn. Laughing attacks started five years after conservative intracranial surgery for a giant basilar aneurysm. Serial neuro-imaging studies revealed a progressive cystic enlargement of the right temporal horn, damaging the baso-lateral temporal cortex. An ictal EEG recording confirmed the epileptic nature of laughing attacks, and showed that the epileptiform activity originated in the right temporal lobe. Complete seizure control was achieved with current doses of diphenilhydantoin. Analysis of this and other previously reported cases, indicate that symptomatic GS may originate in multiple sites of both cerebral hemispheres, although related to the limbic system. The fact that this case exhibited isolated GS stresses the importance of the baso-lateral temporal cortex in the genesis of this type of seizures.

Epilepsia gelástica aislada de inicio tardío secundaria a atrapamiento del asta temporal derecha / Late-onset isolated gelastic epilepsy secondary to entrapment of the right temporal horn

Se comunica el caso de una paciente de 70 años con crisis gelásticas (CG) aisladas secundarias a una forma rara de hidrocefalia focal obstructiva, denominada atrapamiento del asta temporal. Las crisis de risa aparecieron cinco años después de una intervención quirúrgica conservadora sobre un aneurisma basilar gigante. Los estudios seriados de neuroimagen revelaron un ensanchamiento quístico progresivo del asta temporal derecha, que dañaba la región inferolateral de la corteza temporal. El registro EEG durante una crisis confirmó su carácter epiléptico y mostró que las descargas se originaban en el lóbulo temporal derecho. Las crisis se controlaron completamente con dosis habituales de difenilhidantoína. El análisis de este y otros casos de CG sintomáticas indica que estas pueden originarse en lugares distintos de ambos hemisferios cerebrales, aunque relacionados con el sistema límbico. El hecho de que este caso presentase CG aisladas destaca la importancia de la corteza temporal infero-lateral en la génesis de este tipo de crisis epilépticas (AU)