Safety of direct oral provocation in children with mild beta‐lactam hypersensitivity reactions

Pachasidchai, Chayaniss; Suksawat, Yiwa; Yooma, Pailin; Kiewngam, Potjanee; Jotikasthira, Wanlapa; Sawatchai, Adithep; Klangkalya, Natchanun; Kanchongkittiphon, Watcharoot; Manuyakorn, Wiparat

doi:10.1111/pai.13927

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Skin tests were conducted exclusively on patients who tested positive for DPT following the confirmation of allergies, showing a 13.33% positivity rate ( 57 ). Another study included 153 children who underwent direct DPT, revealing only 1.9% of reactions ( 128 ). Both studies concluded that direct DPT is a safe method for mild cutaneous NIRs.…”

Section: How To Optimize Dpt In Children?mentioning

confidence: 99%

“…However, little evidence is published for direct DPT for IRs in children. Although it appears to be safe for benign immediate urticaria/angioedema based on several articles, the number of participants included in these studies is limited ( 128 , 130 , 144 ). The largest study to date included a cohort of over 1,900 children with reported history of benign reactions to amoxicillin limited to the skin.…”

Section: How To Optimize Dpt In Children?mentioning

confidence: 99%

“…DPT continues to be widely regarded as the gold standard for confirming or excluding drug allergies (126). Although there is no consensus regarding DPT protocols, there is evidence on the safety and efficacy of DPT in children depending on risk stratification (42,57,76,111,(127)(128)(129)(130)(131)(132)(133). One of the first questions that emerge is: when is it considered low, moderate, or high risk?…”

Section: How To Optimize Dpt In Children?mentioning

confidence: 99%

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Approach for delabeling beta-lactam allergy in children

Sáenz de Santa María,

Bogas,

Labella

et al. 2023

Front. Allergy

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A considerable number of pediatric patients treated with beta-lactam (BL) antibiotics develop delayed onset of skin rashes during the course of treatment. Although the most frequent cause of these symptoms is infectious, many cases are labeled as allergic reactions to these drugs. BL allergy labels could have a negative impact, as they imply avoidance of this group of drugs and the use of second-line antibiotics, leading to a potential increase in adverse effects and the utilization of less effective therapies. This constitutes a major public health concern and economic burden, as the use of broad-spectrum antibiotics can result in multidrug-resistant organisms and prolonged hospital stays. Therefore, it is crucial to delabel patients during childhood to avoid false labeling in adult life. Although the label of BL allergy is among the most frequent causes of allergy referral, its management remains controversial, and new diagnostic perspectives are changing the paradigm of managing BL allergies in children. Traditionally, drug provocation testing (DPT) was exclusively performed in patients who had previously obtained negative results from skin tests (STs). However, the sensitivity of STs is low, and the role of in vitro testing in the pediatric population is not well defined. Recent studies have demonstrated the safety of direct DPT without prior ST or serum tests for pediatric patients who report a low-risk reaction to BLs, which is cost-effective. However, there is still a debate on the optimal allergic workup to be performed in children with a benign immediate reaction and the management of children with severe cutaneous adverse drug reactions. In this review, we will discuss the impact of the label of BL allergy and the role of the different tools currently available to efficiently address BL allergy delabeling in children.

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Section: How To Optimize Dpt In Children?mentioning

confidence: 99%

Section: How To Optimize Dpt In Children?mentioning

confidence: 99%

Section: How To Optimize Dpt In Children?mentioning

confidence: 99%

See 1 more Smart Citation

Approach for delabeling beta-lactam allergy in children

Sáenz de Santa María,

Bogas,

Labella

et al. 2023

Front. Allergy

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“…10 Identifying low-risk β-lactam allergy children and proceeding directly to DPT could be safe and avoid a false label in adult life. In fact, a prospective study carried out by Chayaniss Pachasidchai et al 11 from January 2021 to April 2022, in which 154 children were included, concluded that the 2-step direct oral DPT without prior skin test and continued for 5 days is an effective and safe method to delabel suspected β-lactam allergies in low-risk children. The tendency beyond reducing unnecessary tests in this population, standing for direct DPT, is to prioritize less time-consuming protocols.…”

Section: New Perspectives On Drug Allergy In Childrenmentioning

confidence: 99%

New perspectives on drug allergy in children

Labella

Eigenmann

Caubet

et al. 2023

Pediatric Allergy Immunology

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Reaction Risk to Direct Penicillin Challenges

Blumenthal,

Smith,

Mann

et al. 2024

JAMA Intern Med

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ImportanceWhile direct penicillin challenges might support the expansion of penicillin allergy delabeling efforts, the perceived risk of reactions remains a key barrier.ObjectiveTo evaluate the frequency of reactions to direct penicillin challenges in individuals with penicillin allergy labels and to identify factors associated with such reactions.Data SourcesThree electronic databases were searched (MEDLINE, Web of Science, and Scopus) from inception to July 19, 2023, for primary studies assessing patients undergoing direct penicillin challenges. Articles were included regardless of publication year, language, status, or definition of allergy risk.Study SelectionTwo reviewers independently selected original studies reporting the frequency of immunologically mediated reactions following a direct penicillin challenge in patients reporting a penicillin allergy.Data Extraction and SynthesisTwo reviewers independently extracted data and independently assessed the quality of each primary study using a risk-of-bias tool for prevalence studies.Main Outcomes and MeasuresThe primary outcome was the frequency of reactions to direct penicillin challenges as calculated using random-effects bayesian meta-analysis of proportions. Secondary outcomes included risk factors for reactions and the frequency of severe reactions.ResultsA total of 56 primary studies involving 9225 participants were included. Among participants, 438 experienced reactions to direct penicillin challenges without prior testing, corresponding to an overall meta-analytic frequency of 3.5% (95% credible interval [CrI], 2.5%-4.6%). Meta-regression analyses revealed that studies performed in North America had lower rates of reaction to direct challenges (odds ratio [OR], 0.36; 95% CrI, 0.20-0.61), while studies performed in children (OR, 3.37; 95% CrI, 1.98-5.98), in outpatients (OR, 2.19; 95% CrI, 1.08-4.75), and with a graded (OR, 3.24; 95% CrI, 1.50-7.06) or prolonged (OR, 5.45; 95% CrI, 2.38-13.28) challenge had higher rates of reaction. Only 5 severe reactions (3 anaphylaxis, 1 fever with rash, and 1 acute kidney injury) were reported, none of which were fatal.Conclusions and RelevanceThis systematic review and meta-analysis found that reactions to direct penicillin challenges are infrequent, with rates comparable to indirect challenges after allergy testing. These findings suggest that direct challenges are safe for incorporation into penicillin allergy evaluation efforts across age groups and clinical settings.

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Safety of direct oral provocation in children with mild beta‐lactam hypersensitivity reactions

Cited by 7 publications

References 10 publications

Approach for delabeling beta-lactam allergy in children

Approach for delabeling beta-lactam allergy in children

New perspectives on drug allergy in children

Reaction Risk to Direct Penicillin Challenges

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