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Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough
Moral, Luis; Latorre, Sara; Toral, Teresa; Marco, Nuria; Canals, Francisco; Forniés, María José; González, María Cristina; García-Avilés, Belén.
Affiliation
  • Moral, Luis; Alicante Institute for Health and Biomedical Research (ISABIAL). Dr. Balmis General University Hospital. Pediatric Allergy and Respiratory Unit. Alicante. Spain
  • Latorre, Sara; Dr. Balmis General University Hospital. Pediatrics Department. Alicante. Spain
  • Toral, Teresa; Alicante Institute for Health and Biomedical Research (ISABIAL). Dr. Balmis General University Hospital. Pediatric Allergy and Respiratory Unit. Alicante. Spain
  • Marco, Nuria; Vega Baja Hospital. Pediatrics Department. Orihuela. Spain
  • Canals, Francisco; Elche General University Hospital. Pediatrics Department. Elche. Spain
  • Forniés, María José; Elche General University Hospital. Pediatrics Department. Elche. Spain
  • González, María Cristina; Elche General University Hospital. Pediatrics Department. Elche. Spain
  • García-Avilés, Belén; Sant Joan d’Alacant University Hospital, Sant Joan d’Alacant. Pediatrics Department. Spain
Allergol. immunopatol ; Allergol. immunopatol;50(5): 148-152, sept. 2022. tab
Article in En | IBECS | ID: ibc-208638
Responsible library: ES1.1
Localization: ES15.1 - BNCS
ABSTRACT
Background: Drug provocation tests (DPTs) are considered the gold standard for diagnosing beta-lactam allergy. However, positive results tend to be mild and difficult to interpret. This study aimed to describe pediatric patients with a presumedly positive or inconclusive DPT, assess the decision to repeat the DPT, and describe its outcome.Methods: Retrospective review of all presumedly positive or inconclusive DPTs performed in six pediatric allergy clinics from 2017 to 2019. We describe the interpretation of results, focusing on the decision to repeat the DPT and its outcome.Results: Of 439 children challenged with a beta-lactam, 26 (5.9%) with a presumedly positive or inconclusive result were included in this study. Most were girls (n = 16, 61.5%), and the median age was 5 years (range 1–13). The initial DPT used amoxicillin (n = 13, 50.0%), amoxicillin-clavulanic acid (n = 12, 46.2%), or cefadroxil (n = 1, 3.8%). Reactions were early (n = 11, 42.3 %), delayed (n = 14, 53.8 %), or not registered (n = 1, 3.8 %), but mild in all cases. A second confirmatory DPT was proposed in 19 patients (73.1%) and performed in 17 patients (65.4%). Nine DPTs were performed from 1 day to 4 months after the first DPT, and the remaining eight took place 6 months to 2 years later. Fifteen children tolerated the drug in the second DPT: 88.2% of those reevaluated and 57.5% of the whole study group.Conclusion: The positive predictive value of DPT may be lower than expected. Given the mildness of observed reactions, a second confirmatory DPT is warranted within a few weeks or months (AU)
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Full text: 1 Collection: 06-national / ES Database: IBECS Main subject: Amoxicillin-Potassium Clavulanate Combination / Beta-Lactams / Drug Hypersensitivity / Amoxicillin / Anti-Bacterial Agents Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Language: En Journal: Allergol. immunopatol Year: 2022 Document type: Article

Full text: 1 Collection: 06-national / ES Database: IBECS Main subject: Amoxicillin-Potassium Clavulanate Combination / Beta-Lactams / Drug Hypersensitivity / Amoxicillin / Anti-Bacterial Agents Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Language: En Journal: Allergol. immunopatol Year: 2022 Document type: Article