Efficacy and Safety of 5-Day Challenge for the Evaluation of Nonsevere Amoxicillin Allergy in Children

Labrosse, Roxane; Paradis, Louis; Lacombe-Barrios, Jonathan; Samaan, Kathryn; Graham, François; Paradis, Jean; Begin, P.; Roches, Anne Des

doi:10.1016/j.jaip.2018.01.030

Cited by 72 publications

(92 citation statements)

References 41 publications

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“…On the other hand, in recent years, it has been suggested not to perform ST in children, in mild‐to‐moderately severe delayed reactions, but to simply prescribe a DPT . Several protocols have been proposed for DPT in children reporting delayed reactions, over a 2‐ to 5‐day period . These protocols refer to children reporting a history of mild reactions, and the authors suggest that increasing the duration of DPT may improve its diagnostic performance without increasing the risk of severe reactions during the observation period or at home.…”

Section: Resultsmentioning

confidence: 99%

“…1,9,10 Several protocols have been proposed for DPT in children reporting delayed reactions, over a 2-to 5-day period. [17][18][19] These protocols refer to children reporting a history of mild reactions, and the authors suggest that increasing the duration of DPT may improve its diagnostic performance without increasing the risk of severe reactions during the observation period or at home. From our personal experience, there is no advantage in the predictive value of DPT if performed over a 1-day period (followed by 48 hours of surveillance at home) or over a more prolonged time.…”

Section: Con Clus Ionmentioning

confidence: 99%

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Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Diaferio

Chiriac

Leoni

et al. 2019

Pediatric Allergy Immunology

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Background There is no perfect agreement on how to perform an allergy workup in suspected beta‐lactam (BL)–allergic children, since skin test (ST)–induced pain is often a limitation. The aim of the study was to assess the possibility of reducing the number of ST in children when performing a complete allergy workup for BL hypersensitivity reactions. Methods A retrospective analysis of all patients referring to the Allergy Unit of the University Hospital of Montpellier (France) with positive responses in immediateand non–immediate‐reading ST to a BL over a 16‐year period was performed, to determine the positive predictive value (PPV) of ST. All pediatric patients with a suspected BL hypersensitivity were skin‐tested with the suspected drug only, during the following 54 months. Results A total of 319 patients reporting 328 BL reactions were included in the retrospective study. The PPV of ST for the reported drug was of 99.4%. Based on the results, the number of patients to include in the prospective study was estimated to be 101. In the prospective study, 229 children were included. We diagnosed a BL hypersensitivity in 12 children (5.2%): Diagnosis was reached in 6 (50.0%) through ST (delayed reading for all) and in 6 through drug provocation test (DPT). Conclusion ST with BL should therefore be performed as a screening test, before DPT, and testing only the suspected drug may be sufficient when dealing with children.

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Section: Resultsmentioning

confidence: 99%

Section: Con Clus Ionmentioning

confidence: 99%

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Diaferio

Chiriac

Leoni

et al. 2019

Pediatric Allergy Immunology

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“…Immediate clinical use of a penicillin following de‐labeling is beneficial to future patient confidence for use. Multi‐day challenges also have the potential to decrease patient anxiety and penicillin avoidance, but this will need to be weighed against the downside of increased antimicrobial exposure …”

Section: Specific Challenges To Allergy De‐labelingmentioning

confidence: 99%

The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

186

160

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Background Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de‐labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus. Methods We performed an evidence‐based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de‐labeling. Over the period 1928‐2018 in Pubmed and Medline, search terms used included “penicillin allergy” or “penicillin hypersensitivity” alone or in combination with “adverse events,” “testing,” “evaluation,” “effects,” “label,” “de‐labeling,” “prick or epicutaneous,” and “intradermal” skin testing, “oral challenge or provocation,” “cross‐reactivity,” and “antimicrobial stewardship”. Results Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance. Conclusions Operationalizing penicillin allergy de‐labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de‐labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.

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“…Other authors suggest that a negative DPT on first dose should be followed by a prolonged provocation over several days since only one out five patients was positive on the first dose . Moreover, in children with a history of BLs hypersensitivity, 5‐day DPTs, without preceding STs, were indicated to be a safe and effective manner to rule out BL‐induced NIR . Additionally, in patients with stable chronic ischaemic heart disease and histories of nonsevere hypersensitivity reactions to aspirin/NSAIDs, an aspirin challenge is advisable …”

Section: Diagnosismentioning

confidence: 99%

“…94 Moreover, in children with a history of BLs hypersensitivity, 5-day DPTs, without preceding STs, were indicated to be a safe and effective manner to rule out BL-induced NIR. 48,95 Additionally, in patients with stable chronic ischaemic heart disease and histories of nonsevere hypersensitivity reactions to aspirin/NSAIDs, an aspirin challenge is advisable. 96 During DPT performance, subjective symptoms due to anxiety…”

Section: In Vivo Testsmentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Efficacy and Safety of 5-Day Challenge for the Evaluation of Nonsevere Amoxicillin Allergy in Children

Cited by 72 publications

References 41 publications

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

The challenge of de‐labeling penicillin allergy

Recent developments and highlights in drug hypersensitivity

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