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To challenge or not to challenge: Literature data on the positive predictive value of skin tests to beta-lactams. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2404-2408.e11. [PMID: 30844483 DOI: 10.1016/j.jaip.2019.01.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/31/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022]
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Genetic and nongenetic factors that may predispose individuals to allergic drug reactions. Curr Opin Allergy Clin Immunol 2018; 18:325-332. [DOI: 10.1097/aci.0000000000000459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yakarıca Ergen G, Erdogan H, Dilek Sirinoğlu F, Oba S, Cetinkaya F. Knowledge and experience regarding perioperative anaphylaxis among anesthesiologists in Istanbul. AIMS ALLERGY AND IMMUNOLOGY 2017. [DOI: 10.3934/allergy.2017.3.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fox SJ, Park MA. Penicillin skin testing is a safe and effective tool for evaluating penicillin allergy in the pediatric population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 2:439-44. [PMID: 25017533 DOI: 10.1016/j.jaip.2014.04.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/30/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Penicillin skin testing has been validated in the evaluation of adult patients with penicillin allergy. However, the commercially available benzylpenicilloyl polylysine (Pre-Pen) is not indicated in the pediatric population. Moreover, the safety and validity of penicillin skin testing in the pediatric population has not been well studied. OBJECTIVE We describe the safety and validity of penicillin skin testing in the evaluation of children with a history of penicillin allergy. METHODS Children (<18 years) with a history of penicillin allergy were evaluated with penicillin skin tests and were reviewed for basic demographics, penicillin skin test results, adverse drug reaction to penicillin after penicillin skin test, and adverse reaction to penicillin skin test. By using the χ(2) test, we compared the differences in the proportion of children and adults with a positive penicillin skin test. P value (<.05) was considered statistically significant. The institutional review board approved the study, and all the subjects signed written informed consents. RESULTS A total of 778 children underwent penicillin skin testing; 703 of 778 patients had a negative penicillin skin test (90.4%), 66 had a positive test (8.5%), and 9 had an equivocal test (1.1%). Children were more likely to have a positive penicillin skin test (P < .0001) compared with adults (64 of 1759 [3.6%]); 369 of 703 patients with negative penicillin skin test (52%) were challenged with penicillin, and 14 of 369 patients (3.8%) had an adverse drug reaction. No adverse reactions to penicillin skin testing were observed. CONCLUSION Penicillin skin testing was safe and effective in the evaluation of children with a history of penicillin allergy.
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Affiliation(s)
| | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
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Picard M, Paradis L, Bégin P, Paradis J, Des Roches A. Skin testing only with penicillin G in children with a history of penicillin allergy. Ann Allergy Asthma Immunol 2014; 113:75-81. [PMID: 24856884 DOI: 10.1016/j.anai.2014.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/15/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The absence of commercially available penicilloyl-polylysine (PPL) for most of the last decade severely hampered the practice of penicillin allergy evaluation because skin testing without PPL is reported to have a poor negative predictive value (NPV). OBJECTIVE To determine the safety and NPV of skin testing without PPL using only penicillin G followed by a 3-dose graded challenge to the incriminated penicillin in children with a history of penicillin allergy. METHODS Patients evaluated for a history of penicillin allergy at the CHU Sainte-Justine Allergy Clinic between December 2006 and December 2009 were skin tested only with penicillin G and underwent a 3-dose graded challenge to the culprit penicillin if the skin test result was negative. RESULTS Among 563 patients skin tested to penicillin G, 185 (33%) had a positive skin test result. These patients had a shorter interval between the initial reaction and skin testing compared with patients with a negative skin test result (P = .03). A total of 375 of 378 patients (99%) with a negative skin test result were challenged and 18 (4.8%) reacted, translating into a NPV of 95.2% (95% confidence interval [CI], 92.5%-97.1%). Three of 17 patients with a history of anaphylaxis and a negative skin test result reacted to challenge (NPV, 82.4%; 95% CI, 59.0-93.8%). All challenge reactions were mild and resolved promptly with treatment. CONCLUSION Among children with a history of penicillin allergy, skin testing only with penicillin G followed by a 3-dose graded challenge to the incriminated penicillin is safe and yields a good NPV. This approach could be useful when PPL is unavailable.
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Affiliation(s)
- Matthieu Picard
- Division of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Louis Paradis
- Division of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Philippe Bégin
- Division of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Jean Paradis
- Division of Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Anne Des Roches
- Division of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.
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Moral L, Garde J, Toral T, Fuentes M, Marco N. Short protocol for the study of paediatric patients with suspected betalactam antibiotic hypersensitivity and low risk criteria. Allergol Immunopathol (Madr) 2011; 39:337-41. [PMID: 21429652 DOI: 10.1016/j.aller.2010.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 09/29/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Suspected hypersensitivity to betalactam antibiotics in children is a frequent cause of consultation that proves costly in terms of resource utilization--particularly time. Such hypersensitivity is, however, rarely confirmed. METHODS A short protocol was introduced in which patients at low risk (single episode with mild, non-immediate skin symptoms after the administration of a betalactam antibiotic via the oral route) were subjected to oral provocation (following the obtaining of informed consent) without any other prior evaluations. Patients failing to meet these requirements were studied according to the protocol of the EAACI (specific IgE and skin testing prior to oral provocation). RESULTS A total of 78 patients (56 at low risk) were studied. Five patients had tolerated the medication after the episode, while another six patients failed to complete the study. The study with oral provocation was completed in the remaining 67 patients: according to the protocol of the EAACI in 17 patients, and using the short protocol in 50 patients. Only one patient showed a positive provocation test, of a delayed and mild nature. CONCLUSIONS Direct oral provocation in low risk patients has been shown to be effective and safe in discarding hypersensitivity to betalactam antibiotics in the majority of the patients studied.
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Lavaud F, Mouton C, Ponvert C. Les tests cutanés dans le bilan diagnostique des réactions d’hypersensibilité peranesthésiques. ACTA ACUST UNITED AC 2011; 30:264-79. [DOI: 10.1016/j.annfar.2010.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fox S, Park MA. Penicillin skin testing in the evaluation and management of penicillin allergy. Ann Allergy Asthma Immunol 2010; 106:1-7. [PMID: 21195938 DOI: 10.1016/j.anai.2010.05.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/19/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE to review the role of penicillin skin testing in the evaluation and management of penicillin allergy mediated by IgE. DATA SOURCES PubMed and OVID search of English-language articles regarding penicillin allergy, penicillin allergy testing, and management of penicillin allergy. STUDY SELECTION articles pertinent to the subject matter were selected and reviewed. RESULTS the major determinant (benzylpenicillin polylysine) detects the greatest number of penicillin allergic patients during skin testing, and the minor determinants of penicillin increase the sensitivity of penicillin skin testing. Penicillin skin testing to the major and minor determinants was found to have a negative predictive value of 97% to 99%. The incidence of systemic adverse reaction to penicillin skin testing is less than 1%. CONCLUSION a detailed history of the prior reaction to penicillin is an integral part of the evaluation, but it is not accurate in predicting a positive penicillin skin test result. A patient with a negative penicillin skin test result to the major and minor determinants is at a low risk of an immediate-type hypersensitivity reaction to penicillin. Patients with a positive skin test result should undergo desensitization to penicillin or an alternative antibiotic should be considered.
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Affiliation(s)
- Stephanie Fox
- Mayo Clinic College of Medicine and Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
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Becker KL, Snider R, Nylen ES. Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target. Br J Pharmacol 2010; 159:253-64. [PMID: 20002097 PMCID: PMC2825349 DOI: 10.1111/j.1476-5381.2009.00433.x] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 06/17/2009] [Accepted: 06/29/2009] [Indexed: 02/06/2023] Open
Abstract
The worldwide yearly mortality from sepsis is substantial, greater than that of cancer of the lung and breast combined. Moreover, its incidence is increasing, and its response to therapy has not appreciably improved. In this condition, the secretion of procalcitonin (ProCT), the prohormone of calcitonin, is augmented greatly, attaining levels up to thousands of fold of normal. This hypersecretion emanates from multiple tissues throughout the body that are not traditionally viewed as being endocrine. The serum values of ProCT correlate with the severity of sepsis; they recede with its improvement and worsen with exacerbation. Accordingly, as highlighted in this review, serum ProCT has become useful as a biomarker to assist in the diagnosis of sepsis, as well as related infectious or inflammatory conditions. It is also a useful monitor of the clinical course and prognosis, and sensitive and specific assays have been developed for its measurement. Moreover, it has been demonstrated that the administration of ProCT to septic animals greatly increases mortality, and several toxic effects of ProCT have been elucidated by in vitro experimental studies. Antibodies have been developed that neutralize the harmful effects of ProCT, and their use markedly decreases the symptomatology and mortality of animals that harbour a highly virulent sepsis analogous to that occurring in humans. This therapy is facilitated by the long duration of serum ProCT elevation, which allows for a broad window of therapeutic opportunity. An experimental groundwork has been established that suggests a potential applicability of such therapy in septic humans.
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Affiliation(s)
- Kenneth L Becker
- George Washington University and Veterans Affairs Medical Center, Washington, DC 20422, USA.
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Damme KV, Behets F, Ravelomanana N, Godornes C, Khan M, Randrianasolo B, Rabenja NL, Lukehart S, Cohen M, Hook E. Evaluation of azithromycin resistance in Treponema pallidum specimens from Madagascar. Sex Transm Dis 2009; 36:775-6. [PMID: 19901863 PMCID: PMC3673283 DOI: 10.1097/olq.0b013e3181bd11dd] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treponema pallidum resistance to azithromycin has been documented in the US, Canada, and Ireland. We found no evidence of resistance to azithromycin in specimens from 141 patients with syphilitic lesions in Madagascar suggesting resistance is geographically isolated and supporting use of azithromycin as alternative treatment for early syphilis in Madagascar.
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Affiliation(s)
- Kathleen Van Damme
- University of North Carolina, Madagascar (UNC-MAD), Antananarivo, Madagascar
| | - Frieda Behets
- University of North Carolina at Chapel Hill, NC, USA
| | - Noro Ravelomanana
- University of North Carolina, Madagascar (UNC-MAD), Antananarivo, Madagascar
| | | | - Maria Khan
- University of North Carolina at Chapel Hill, NC, USA
| | - Bodo Randrianasolo
- University of North Carolina, Madagascar (UNC-MAD), Antananarivo, Madagascar
| | | | | | - Myron Cohen
- University of North Carolina at Chapel Hill, NC, USA
| | - Edward Hook
- University of Alabama at Birmingham, AL, USA
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Nagao-Dias AT, Pereira AC, Silva MFE, Néri EDR, Accioly JW, Lima JES. Implementation of a penicillin allergy skin test. BRAZ J PHARM SCI 2009. [DOI: 10.1590/s1984-82502009000300023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The penicillin allergy skin testing is the only accurate and reliable test for penicillin hypersensitivity mediated by IgE. It is useful for identifying patients with doubtful history of allergy. Positive test for major and minor determinants presents a positive predictive value of 50% and negative predictive value of 99%. In Brazil, the Ministry of Health suggests a protocol for in house made reagents, since they are not commercially available. As the referred protocol does not mention some important details about the test procedures, we propose in the present work to implement them, critically evaluating each step in order to allow the protocol establishment at any health service, with quality and safety.
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Lange L, Koningsbruggen SV, Rietschel E. Questionnaire-based survey of lifetime-prevalence and character of allergic drug reactions in German children. Pediatr Allergy Immunol 2008; 19:634-8. [PMID: 18221471 DOI: 10.1111/j.1399-3038.2007.00702.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Data on the epidemiology of adverse drug reactions (ADR), especially allergic drug reactions, in children are rare. The reported prevalence of ADR in pediatric populations varies a lot, depending on type of the study and the country where the data were collected. In order to assess the prevalence of ADR and allergic drug reactions in a population of German children, we conducted a study in a German pediatric university hospital. A questionnaire concerning occurrence and character of ADR was distributed to all parents presenting their children in the hospital for planned admissions or in the emergency department from May 2004 to November 2004. Additional telephone interviews were conducted to specify the reported symptoms in ambiguous cases. One thousand four hundred forty-seven questionnaires were collected. The reported life-time prevalence of ADR according to the information given by the parents was 7.5% (108/1447). Six of the reactions were severe, three children had experienced anaphylactic reactions. In 4.2% (61/1447), the history was suspicious for a potential allergic mechanism because of an immediate or late phase cutaneous drug reaction. In this group, the suspected drugs were antibiotics in 85% (32.7% aminopenicillins, 29.5% other penicillins, 11.5% cefaclor, 8.2% macrolides and 18% others), antiphlogistic and respiratory drugs in 4.9% each and vaccines and contrast media in 3.3% each. There was a higher percentage of children under the age of four suffering from ADR. This trend was not significant when analyzing only the allergic reactions. Forty-four percent of the parents stated, their children suffer from drug allergy, although a clear non-allergic reaction was described. Both, ADR and allergic drug reactions are frequent phenomena in children. It is important to monitor drug therapy for any adverse reaction in order to inform the parents about the character of the adverse reaction, the necessary consequences and to initiate further diagnostic procedures.
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Affiliation(s)
- L Lange
- Children's Hospital, University of Cologne, Cologne, Germany.
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Orhan F, Karakas T, Cakir M, Akkol N, Bahat E, Sonmez FM, Gedik Y. Parental-reported drug allergy in 6- to 9-yr-old urban schoolchildren. Pediatr Allergy Immunol 2008; 19:82-5. [PMID: 17651377 DOI: 10.1111/j.1399-3038.2007.00592.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiologic studies about the prevalence of adverse drug reactions in children are scarce compared to reports in adults. To assess the prevalence of parental-reported drug allergy in 6- to 9-yr-old urban school children, we performed a cross-sectional study of 6- to 9-yr-old urban children from the eastern Black Sea region of Turkey during the year 2004, using a self-administered questionnaire by parents. Response rate was 81.6% (2855/3500). The prevalence of parental-reported drug allergy was 2.8% (81/2855). The most common parental-reported drugs were penicillins and other beta-lactams (59.3%), trimethoprim-sulfamethoxazole (11.1%), and acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (NSAIDs) (9.9%). The most commonly reported clinical manifestations were cutaneous (n = 76, 93.8%) followed by gastrointestinal (n = 17, 21%) symptoms. In 19 (23.5%) children, the reaction involved more than one organ system. Of these 19 children, 14 used beta-lactams. Systemic reactions were not reported with NSAIDs. Medications were taken by mouth in 88.9% of the reactions. Most of the reported allergic reactions occurred in the first day of treatment (61.7%). The reported time to reaction after the last intake of the drug was <2 h in 35 (43.2%) children and 2-24 h in 45 (55.6%). Oral reactions occurred later than reactions to parentally administered drugs. Parents of 58 children (71.6%) reported that they completely avoided the suspected culprit drug following the reaction. Relapse occurred after re-administration of the drug in 21 (25.9%) children. A diagnostic approach for drug allergy was not undertaken in any of the children. This study may provide some information about the prevalence of drug allergy, although it is based on parental perception and results are unlikely to conform well to true prevalence.
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Affiliation(s)
- Fazil Orhan
- Department of Pediatrics, and Division of Pediatric Allergy, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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Cetinkaya F, Ozturk AO, Kutluk G, Erdem E. Penicillin sensitivity among hospital nurses without a history of penicillin allergy. J Adv Nurs 2007; 58:126-9. [PMID: 17445015 DOI: 10.1111/j.1365-2648.2006.04155.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper reports a study to document the prevalence of penicillin sensitivity among nurses who had no previous history of sensitivity and worked in an inner city hospital in Turkey. BACKGROUND Frequent and prolonged exposure to any drug including penicillin may increase the risk of hypersensitivity to these drugs. Local administration of drugs increases the likelihood of sensitization. Nurses are the main group of healthcare workers who prepare and administer antibiotics to patients, so they may be at highest risk for sensitization. Skin testing with major and minor determinants of penicillin has proved useful for identifying penicillin-specific IgE antibodies in sensitized individuals. METHOD Skin prick tests were performed with benzyl penicilloyl polylysine (PPL) and a mixture of minor antigenic determinants (MDM) solution with 83 nurses who had been handling beta-lactam antibiotics. The study was conducted in 2004. FINDINGS Ten nurses (12%) had positive skin reactions to penicillin antigens. Six were sensitive to PPL (7 x 2%) and four were sensitive to MDM (4 x 8%). CONCLUSION Occult sensitization to beta-lactam antibiotics, without symptoms, may develop in hospital nurses. It is possible that these healthcare workers might be at increased risk of hypersensitivity reactions should they be exposed to beta-lactams, administered for therapeutic purposes. Further research is needed to explore this important issue.
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Affiliation(s)
- Feyzullah Cetinkaya
- Department of Pediatrics and Allergy, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
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Roberts JA, Hsu M, Allen K, Willis J, Barras M. Pharmacists Investigating Adverse Penicillin Responses-Pilot Study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2007. [DOI: 10.1002/j.2055-2335.2007.tb00744.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jason A Roberts
- Royal Brisbane and Women's Hospital, and Burns Trauma and Critical Care Research Centre; University of Queensland
| | - Millie Hsu
- School of Pharmacy; University of Queensland
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Ponvert C, Weilenmann C, Wassenberg J, Walecki P, Bourgeois ML, de Blic J, Scheinmann P. Allergy to betalactam antibiotics in children: a prospective follow-up study in retreated children after negative responses in skin and challenge tests. Allergy 2007; 62:42-6. [PMID: 17156340 DOI: 10.1111/j.1398-9995.2006.01246.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Up to 10% of the patients in whom suspected betalactam hypersensitivity (HS) has been excluded by skin and challenge tests report suspected allergic reactions during subsequent treatments with the same or very similar betalactams. It has been suggested that the reactions may result from a resensitization induced by the challenge performed at the time of the allergological work-up. However, most patients did not undergo a second allergological work-up, to determine if the reactions resulted from betalactam HS or not. OBJECTIVES We aimed to determine if children diagnosed nonallergic to betalactams have tolerated subsequent treatments with the initially suspected and/or other betalactams, and, in case of a reaction, if the reaction resulted from betalactam HS. METHODS We sent a questionnaire concerning the clinical history of their children to the parents of 256 children previously diagnosed nonallergic to betalactams. A second allergological work-up was performed in the children reporting suspected allergic reactions during subsequent treatments with the same and/or other betalactams. Skin tests were performed with the soluble form of the suspected (or very similar) betalactams and other betalactams from the same and other classes. Skin test responses were assessed at 15-20 min (immediate), 6-8 h (semi-late) and 48-72 h (late). Oral challenge (OC) was performed in children with negative skin tests, either at the hospital (immediate and accelerated reactions), or at home (delayed reactions). RESULTS A response was obtained from 141 children (55.3%). Forty-eight (34%) of those children had not been treated with the betalactams for whom a diagnosis of allergy had been ruled out previously. Seven (7.5%) of the 93 children who had been treated again reported suspected allergic reactions. Skin tests and OC were performed in six of those children, and gave negative results in five children. In one child previously diagnosed nonallergic to amoxicillin associated with clavulanic acid, we diagnosed a delayed HS to clavulanic acid and a serum sickness-like disease to cefaclor. Thus, the frequency of reactions resulting from betalactam HS in children with negative skin and challenge tests is very low, and does not exceed 2.1% (2/93) if we consider that the child which refused a second allergological work-up is really allergic to betalactams. CONCLUSION Our results in a very large number of children show that reactions presumed to result from betalactam HS are rare in children in whom the diagnosis of betalactam allergy has been ruled out previously. Moreover, they suggest that, as shown for the initial reactions, most of the reactions during subsequent treatments are rather a consequence of the infectious diseases for whom betalactams have been prescribed than a result of betalactam HS. Finally, they suggest that the risk of resensitization by OC is very low, and do not support the notion that skin testing should be repeated in children diagnosed nonallergic to betalactams.
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Affiliation(s)
- C Ponvert
- Department of Pediatrics, Pulmonology & Allergy Unit, Paris V University, Sick Childrens Hospital, Paris, France
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Abstract
PURPOSE OF REVIEW Hypersensitivity drug reactions are but one of the many different types of adverse drug reactions. They may be potentially life-threatening, prolong hospitalization, affect drug prescribing patterns of physicians and result in socioeconomic costs. This review summarizes current knowledge on the incidence, prevalence, mortality and risk factors for these reactions in different populations. RECENT FINDINGS Hypersensitivity reactions represent about one third of all adverse drug reactions. Adverse drug reactions affect 10-20% of hospitalized patients and more than 7% of the general population. Severe reactions including anaphylaxis, drug hypersensitivity syndromes, Stevens Johnson syndrome and toxic epidermal necrolysis are also associated with significant morbidity and mortality. Although several risk factors have been identified, their clinical importance has not been fully understood. Future progress in immunogenetics and pharmacogenetics may help identify populations at risk for specific types of reactions. SUMMARY Well designed epidemiological studies on hypersensitivity drug reactions are lacking as most studies have been on adverse drug reactions. Such studies will be helpful in identifying patients at risk of developing such reactions, in particular severe reactions, and implementing early preventive measures.
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Affiliation(s)
- Eva Rebelo Gomes
- Allergy Department, INSERM U454 - IFR3, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000175939.68435.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2004. [DOI: 10.1002/pds.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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