Oral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity

Non‐immediate‐reading skin tests and prolonged challenges in non‐immediate hypersensitivity to beta‐lactams in children

“…Even in children with EMM, SJS and SSLRs and negative ST results, DPT with the suspected drugs were safely performed at home, and none of the 43 children with a positive DPT reported a severe reaction. Thus, although prolonged DPT may have potential side effects (potentially severe reactions and selection of resistant microorganisms), our findings support that prolonged DPT with therapeutic doses can be safely performed in children reporting non‐immediate and non‐severe reactions …”

“…The optimal duration of DPT for the diagnosis of non‐immediate hypersensitivity to drugs in children remains unknown. Although a 2‐days DPT protocol is effective, increasing its duration may improve its diagnostic performance without increasing the risk of severe reactions . Moreover, ruling‐out a suspected diagnosis of BL allergy is associated with a decreased use of alternate antibiotics, often more costly and less efficient, a decreased selection of multiresistant bacteria, and a decreased number of treatments and/or hospitalizations .…”

The 3 Cs of Antibiotic Allergy—Classification, Cross-Reactivity, and Collaboration

“…In some cases of appropriately selected phenotypes (MPE) and implicated antibiotics (penicillin or aminopenicillin), direct oral challenge without skin testing has been safely employed to exclude non-immediate hypersensitivity. 121, 122 Prior studies have previously demonstrated that childhood antibiotic associated exanthems or non-immediate hypersensitivities were difficult to reproduce on oral challenge. 96 The “pickup” of non-immediate hypersensitivity has been improved when a prolonged oral challenge (5–7 days) has been employed.…”

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 . 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.…”