The diagnosis and management of antibiotic allergy in children: Systematic review to inform a contemporary approach

Marrs, Tom; A, Fox; Lack, Gideon; Toit, George Du

doi:10.1136/archdischild-2014-306280

Cited by 41 publications

(21 citation statements)

References 45 publications

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“…Due to the paucity of reliable data, it is difficult to assess the real value of skin tests to drugs in children, because most publications reporting skin test results are older, have neither used actual recommended protocols, nor have included DPTs and have validated their results only against the clinical history. Recent reports showed that the evidence to date does not clearly lean in favor or against skin testing in children .…”

Section: Diagnostic Approach To Drug Hypersensitivity In Childrenmentioning

confidence: 99%

Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

Gomes

Brockow

Kuyucu

et al. 2015

Allergy

254

336

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When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sicknesslike reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.

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Section: Diagnostic Approach To Drug Hypersensitivity In Childrenmentioning

confidence: 99%

Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

Gomes

Brockow

Kuyucu

et al. 2015

Allergy

254

336

View full text Add to dashboard Cite

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“…Patients with a history compatible with anaphylaxis were not excluded from the study of Mill et al but, unfortunately, no such case was finally recruited, so their conclusions could not be generalized to those patients. A recent systematic review from Marrs et al concluded that suspected non‐serious antibiotic allergy should be primarily investigated using OPT‐based clinical protocols . Of interest, it must be recognized that the current classification of BLH reactions as immediate or non‐immediate based on the delay from the last dose is not so easy to apply in clinical practice and may be inconsistent .…”

Section: Direct Opt For Children With Suspected Immediate Amoxicillinmentioning

confidence: 99%

“…Sadly, skin tests with amoxicillin, the implicated antibiotic, were not performed alleging the lack of standardized available intradermal tests for amoxicillin and its sensitivity could not be estimated. They concluded that a graded OPT provides an ac- 26 Of interest, it must be recognized that the current classification of BLH reactions as immediate or non-immediate based on the delay from the last dose is not so easy to apply in clinical practice and may be inconsistent. 27 This favors the possibility of an unified management for non-severe cutaneous reactions irrespective of the time elapsed since antibiotic administration.…”

Section: Direct Opt For Children With Suspected Immediate Amoxicillmentioning

confidence: 99%

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

Moral

Caubet

2017

Pediatric Allergy Immunology

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Suspected allergy to penicillins and cephalosporins is very common in childhood. After a proper evaluation, allergy will be confirmed only in a small portion of them. Intradermal tests are usually part of the allergy workup, but they are painful for children and time-consuming, and their role has been debated. A systematic review found only two studies reporting a positive predictive value of skin tests in children of 36% and 33%, respectively, leading to a high rate of inaccurate diagnosis. Moreover, considering that skin tests are negative in more than 90%-95% of cases, an oral provocation test (OPT) is finally needed to confirm tolerance in most of these children. Positive OPT are rare, and even where children demonstrate reproducible signs on challenge, they rarely constitute immediate or serious symptoms. Therefore, OPT to the index antibiotic without skin tests are increasingly being considered an accepted procedure for children with a suspected mild non-immediate reaction related to a beta-lactam antibiotic. Furthermore, a recent research has taken the same approach including children with suspected mild immediate reactions, with similar safety and positive results. In light of recent evidence highlighted, it is now the time for large and multicentric studies to confirm that OPT with the index antibiotic, without skin tests, are safe and convenient for children with a history of a mild reaction with a beta-lactam antibiotic before it can be recommended in pediatric allergy guidelines.

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“…Better evidence for guiding diagnostic and management strategies for paediatric antibiotic allergy is emerging . The most recent paediatric studies, including a systematic review, conclude that there is no rigorous evidence to support skin testing (ST) for the investigation of antibiotic allergy in children, and direct progression to oral provocation challenge (OPC) with the culprit antibiotic in children with a rash can be safely performed . Australian data in this regard are currently missing.…”

mentioning

confidence: 99%

The role of skin testing and extended antibiotic courses in assessment of children with penicillin allergy: An Australian experience

Arnold

Sommerfield

Ramgolam

et al. 2018

J Paediatrics Child Health

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A direct OPC with the culprit drug in Australian children can be safely performed, avoiding resource-intensive and painful ST. Our data demonstrate that a prior history of anaphylaxis does not necessarily predict IgE-mediated allergy, as detected by positive immediate ST or reactions to oral challenge. Such history should not detract from efforts to assess these children for antibiotic allergy. We suggest that extended courses of at least 5 days are important in paediatric antibiotic de-labelling as six children (4.5% of those who were prescribed the extended course) reacted in our study and even developed symptoms late in the extended course, from days 2 to 6.

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The diagnosis and management of antibiotic allergy in children: Systematic review to inform a contemporary approach

Cited by 41 publications

References 45 publications

Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

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

The role of skin testing and extended antibiotic courses in assessment of children with penicillin allergy: An Australian experience

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