Roxane Labrosse1, Louis Paradis2, Jonathan Lacombe-Barrios1, Kathryn Samaan1, François Graham3, Jean Paradis3, Philipps Bégin2, Anne Des Roches4. 1. Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada. 2. Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Allergy and Clinical Immunology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada. 3. Allergy and Clinical Immunology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada. 4. Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada. Electronic address: a.des.roches@umontreal.ca.
Abstract
BACKGROUND: Penicillin allergy is the most frequent drug allergy, among which aminopenicillins are reputed for causing delayed rashes in children, particularly in the context of viral infections. Despite a negative allergy evaluation, a significant proportion of individuals continue to avoid penicillin antibiotics for fear of an allergic reaction. OBJECTIVE: To evaluate the safety and efficacy of a 5-day challenge to amoxicillin and the proportion of subsequent use of amoxicillin. METHODS: Pediatric patients with a history of a reaction to amoxicillin were prospectively recruited in the study. All patients were challenged, and those with negative immediate challenges underwent an ambulatory 5-day challenge to amoxicillin to rule out nonimmediate reactions. Patients were called 2 years after their initial allergy evaluation to assess subsequent amoxicillin use and tolerance. RESULTS: One hundred thirty children with a history of amoxicillin allergy underwent a graded drug provocation test (DPT) to amoxicillin. Three patients had a positive immediate challenge, 3 had a positive nonimmediate challenge, and 2 were equivocal. Of the 122 patients with a negative challenge, 114 (93.4%) were reached 2 years after their initial allergy evaluation: 75 had used antibiotics since, of which only 1 (1.3%) had refused to reuse amoxicillin because of fear of an allergic reaction. Finally, the 5-day DPT resulted in a 24.1% decrease in future penicillin avoidance compared with classical single-dose graded DPT performed for 1 day in a historical cohort (P < .0001). CONCLUSION: The 5-day challenge is a safe and effective way to rule out nonimmediate amoxicillin allergy, and it ensures better compliance with future penicillin use.
BACKGROUND:Penicillinallergy is the most frequent drug allergy, among which aminopenicillins are reputed for causing delayed rashes in children, particularly in the context of viral infections. Despite a negative allergy evaluation, a significant proportion of individuals continue to avoid penicillin antibiotics for fear of an allergic reaction. OBJECTIVE: To evaluate the safety and efficacy of a 5-day challenge to amoxicillin and the proportion of subsequent use of amoxicillin. METHODS: Pediatric patients with a history of a reaction to amoxicillin were prospectively recruited in the study. All patients were challenged, and those with negative immediate challenges underwent an ambulatory 5-day challenge to amoxicillin to rule out nonimmediate reactions. Patients were called 2 years after their initial allergy evaluation to assess subsequent amoxicillin use and tolerance. RESULTS: One hundred thirty children with a history of amoxicillinallergy underwent a graded drug provocation test (DPT) to amoxicillin. Three patients had a positive immediate challenge, 3 had a positive nonimmediate challenge, and 2 were equivocal. Of the 122 patients with a negative challenge, 114 (93.4%) were reached 2 years after their initial allergy evaluation: 75 had used antibiotics since, of which only 1 (1.3%) had refused to reuse amoxicillin because of fear of an allergic reaction. Finally, the 5-day DPT resulted in a 24.1% decrease in future penicillin avoidance compared with classical single-dose graded DPT performed for 1 day in a historical cohort (P < .0001). CONCLUSION: The 5-day challenge is a safe and effective way to rule out nonimmediate amoxicillinallergy, and it ensures better compliance with future penicillin use.
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