María Dolores Ibáñez1, Pablo Rodríguez Del Río2, Eva Maria Lasa3, Alejandro Joral3, Javier Ruiz-Hornillos4, Candelaria Muñoz5, Carmen Gómez Traseira6, Carmelo Escudero2, Jose María Olaguibel Rivera7, Teresa Garriga-Baraut8, David González-de-Olano9, Ana Rosado10, Silvia Sanchez-García2, Socorro Pérez Bustamante11, Maria Antonia Padial Vilchez12, Patricia Prieto Montaño13, Rocío Candón Morillo14, Eva Macías Iglesia15, Angélica Feliú Vila16, Teresa Valbuena12, Ana Lopez-Patiño17, Antonio Martorell18, Joaquín Sastre19, María Teresa Audícana20. 1. Allergy Department, Niño Jesús University Children's Hospital, Madrid, Spain; The Research Network ARADyAL RD16/0006/0026. Electronic address: mibanezs@salud.madrid.org. 2. Allergy Department, Niño Jesús University Children's Hospital, Madrid, Spain; The Research Network ARADyAL RD16/0006/0026. 3. Allergy Department, Hospital Universitario Donostia, Guipuzcoa, Spain. 4. Allergy Department, Hospital Universitario Infanta Elena, Valdemoro, Spain; Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain. 5. Allergy Department. Children Hospital, University Regional Hospital, Málaga, Spain. 6. Allergy Department, Hospital La Paz Institute for Health Research, Madrid, Spain. 7. Servicio de Alergologia, Complejo Hospitalario de Navarra, Pamplona, Spain. 8. Unitat d'Al.lergologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup Creixement i Desenvolupament, Institut de Recerca Vall d'Hebron, Barcelona, Spain. 9. Allergy Unit, Hospital Universitario Fuenlabrada, Madrid, Spain. 10. Unidad de Alergia, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 11. Allergy Department, Torrejon University Hospital, Madrid, Spain; Allergy Department, Rincon Health Group, Vithas, Málaga, Spain. 12. Servicio Alergología, Hospital Infanta Sofia, SS Reyes, Madrid, Spain. 13. Servicio de Alergología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. 14. Allergy Department, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain. 15. Allergy Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain. 16. Allergy Department, Hospital del Tajo, Aranjuez, Spain. 17. Allergy Unit, Xarxa Santa Tecla, Tarragona, Spain. 18. Allergy Department, University General Hospital, Valencia, Spain. 19. Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain; Allergy Department, Fundación Jimenez Diaz, Madrid, Spain; Facultad de Universidad Autonoma de Madrid, Madrid, Spain. 20. Allergy Department. Hospital Universitario Araba (HUA), Instituto Bioaraba, Vitoria, Spain.
Abstract
BACKGROUND: Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use. OBJECTIVE: To assess the accuracy of tools for diagnosis of penicillin allergy in children. METHODS: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs). RESULTS: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007). CONCLUSION: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children.
BACKGROUND: Diagnostic guidelines for penicillinallergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use. OBJECTIVE: To assess the accuracy of tools for diagnosis of penicillinallergy in children. METHODS: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs). RESULTS: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillinallergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergicpatients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillinallergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007). CONCLUSION: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillinallergy in children.
Authors: Rashmeet Bhogal; Abid Hussain; Ariyur Balaji; William H Bermingham; John F Marriott; Mamidipudi T Krishna Journal: Int J Clin Pharm Date: 2021-01-13
Authors: Kyra Y L Chua; Sara Vogrin; Susan Bury; Abby Douglas; Natasha E Holmes; Nixon Tan; Natasha K Brusco; Rebecca Hall; Belinda Lambros; Jacinta Lean; Wendy Stevenson; Misha Devchand; Kent Garrett; Karin Thursky; M Lindsay Grayson; Monica A Slavin; Elizabeth J Phillips; Jason A Trubiano Journal: Clin Infect Dis Date: 2021-08-02 Impact factor: 9.079