The use of in vivo and in vitro tests in children with beta lactam allergy

Akçal, Ömer; Özen, Selime; Taşkırdı, I.; Hacı, İdil Akay; Kanık, Esra Toprak; Karkıner, Canan Şule Ünsal; Can, Demet

doi:10.1016/j.aller.2020.03.013

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…15,22,24 Considered less immunogenic than other BLs, 26 its contribution to both IR and NIR in adults has been reported. 27 The proportion of confirmed IRs was 8.3%, with SIgE contributing in a very low number of cases as reported 28 and the combination of in vitro testing plus ST contributed in the 5.4%. These values are lower than the 17% reported by Ibañez et al 16 but higher than the results observed by Mill et al 29 One study even reported a proportion of 86% positive ST, 21 but these data have not been supported by other studies.…”

Section: Discussionmentioning

confidence: 88%

Patterns of response and drugs involved in hypersensitivity reactions to beta‐lactams in children

Torres-Rojas

Pérez-Alzate

Somoza

et al. 2021

Pediatric Allergy Immunology

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Background: Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. Methods: Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and non-immediate reactions. The workup included sIgE, skin testing, and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for non-immediate ones.Results: Of the 510 children included, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%).Among non-immediate reactions (11.4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6-7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities.Conclusions: There were few confirmed cases of either type of reaction. Skin testing proved less valuable in non-immediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have non-immediate reactions, while clavulanic acid selectivity was exclusive to the non-immediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation.

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