Direct oral challenge for immediate and non‐immediate beta‐lactam allergy in children: A real‐world multicenter study

Background Allergy to beta‐lactam antibiotics (BLA) is frequently suspected in children, but a drug provocation test (DPT) rules it out in over 90% of cases. Direct oral DPT (DODPT), without skin or other previous tests, is increasingly been used to delabel non‐immediate BLA reactions. This real‐wor...

Full description

Saved in:

Bibliographic Details
Published in:	Pediatric allergy and immunology Vol. 35; no. 3; pp. e14096 - n/a
Main Authors:	Moral, Luis, Toral, Teresa, Muñoz, Candelaria, Marco, Nuria, García‐Avilés, Belén, Murcia, Laura, Forniés, María José, González, María Cristina, Canals, Francisco, Bragado, Esther, Martínez Olmos, Javier, García‐Magán, Carlos, Moure González, José Domingo, Cortés, Nuria, Giménez, Magalí, Gómez, Catalina, Rodríguez, Ana Belén, Moreno, Ana, Lucas, José Manuel, Quevedo, Sergio, Blasco, Cristina, Aliaga, Yolanda
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-03-2024
Subjects:	Allergies Anaphylaxis Anaphylaxis - chemically induced Anti-Bacterial Agents - adverse effects Antibiotics beta-Lactams beta‐lactam allergy Child Children Drug Hypersensitivity - diagnosis Drug Hypersensitivity - epidemiology drug provocation test Enterocolitis Humans Hypersensitivity (immediate) Inflammatory bowel disease Monobactams Patients Pediatrics Primary care safety Side effects Skin tests Skin Tests - methods Spain beta-lactam allergy drug provocation test children safety
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background Allergy to beta‐lactam antibiotics (BLA) is frequently suspected in children, but a drug provocation test (DPT) rules it out in over 90% of cases. Direct oral DPT (DODPT), without skin or other previous tests, is increasingly been used to delabel non‐immediate BLA reactions. This real‐world study aimed to assess the safety and effectiveness of DODPT in children with immediate and non‐immediate reactions to BLAs. Methods Ambispective registry study in children (<15 years), attended between 2016 and 2023 for suspected BLA allergy in 15 hospitals in Spain that routinely perform DODPT. Results The study included 2133 patients with generally mild reactions (anaphylaxis 0.7%). Drug provocation test with the implicated BLA was performed in 2014 patients (94.4%): 1854 underwent DODPT (86.9%, including 172 patients with immediate reactions). One hundred forty‐five (7.2%) had symptoms associated with DPT, although only four reactions were severe: two episodes of anaphylaxis and two of drug‐induced enterocolitis syndrome, which resolved rapidly with treatment. Of the 141 patients with mild reactions in the first DPT, a second DPT was considered in 87 and performed in 57, with 52 tolerating it without symptoms. Finally, BLA allergy was ruled out in 90.9% of the sample, confirmed in 3.4%, and remained unverified, usually due to loss to follow‐up, in 5.8%. Conclusions Direct oral DPT is a safe, effective procedure even in immediate mild reactions to BLA. Many reactions observed in DPT are doubtful and require confirmation. Severe reactions are exceptional and amenable to treatment. Direct oral DPT can be considered for BLA allergy delabeling in pediatric primary care.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0905-6157 1399-3038
DOI:	10.1111/pai.14096