No need for skin and in vitro tests in most children with suspected allergy to beta‐lactam antibiotics

Abstract

educating patients about the management of possible systemic reactions, are followed when treating patients. Moreover, further investigations concerning the in-season administration of the five-grass pollen tablet will be needed.

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

“…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 .…”

“…Pediatricians, though, are aware that intradermal tests (IDTs) and even skin prick tests (SPTs) are associated with a significant discomfort for children and parents. For this reason, sometimes, the allergy workup is postponed and children avoid this class of antibiotics without having a true drug hypersensitivity . In the recent EAACI Drug Allergy Interest Group pediatric Task Force on Drug Hypersensitivity in children, a general diagnostic algorithm for DHR evaluation in children was proposed: Clinicians may perform a DPT without previously skin‐testing the patient, in the case of non‐immediate reactions manifesting as mild cutaneous exanthemas (the most prevalent hypersensitivity manifestation in childhood), based on one study in which such children were seen at the acute phase by a doctor of the allergy unit, to ascertain the low severity of the reaction, and then underwent ST and a DPT to the culprit drug .…”

“…In recent years, some authors proposed to avoid ST in children, while older European Academy of Allergy and Clinical Immunology (EAACI) guidelines, together with other authors' recommendations, still underline the importance of testing several different molecules of the BL family, when evaluating patients of any age for a suspicion of DHR. [6][7][8][9][10][11] Pediatricians, though, are aware that intradermal tests (IDTs) and even skin prick tests (SPTs) are associated with a significant discomfort for children and parents. For this reason, sometimes, the allergy workup is postponed and children avoid this class of antibiotics without having a true drug hypersensitivity.…”

Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

“…On the other side, a large number of children have to be skin‐tested, but most of them (those with negative results) need an OPT to be anyway performed to identify the small number of patients truly allergic or to formally exclude it. As an example, an analysis over a series of 783 children studied by Zambonino et al showed that if OPT would have been performed directly, 66 in vitro tests and 781 skin tests would have been spared, resulting in only 6 additional OPT (in those few patients with positive in vitro or skin tests) to the other 777 performed . Because of the relative lack of studies, the pediatric guidelines for the management of drug hypersensitivity in children have been based on “expert” opinions held within long‐standing practice, resulting in far too many inaccurate and painful intradermal tests among children.…”

“…As an example, an analysis over a series of 783 children studied by Zambonino et al 15 showed that if OPT would have been performed directly, 66 in vitro tests and 781 skin tests would have been spared, resulting in only 6 additional OPT (in those few patients with positive in vitro or skin tests) to the other 777 performed. 16 Because of the relative lack of studies, the pediatric guidelines for the management of drug hypersensitivity in children have been based on "expert" opinions held within long-standing practice, resulting in far too many inaccurate and painful intradermal tests among children. But new guidelines are now incorporating recent evidence and OPT without skin tests are recommended for mild non-immediate suspected reactions.…”