Diagnostic evaluation of hypersensitivity reactions to beta-lactam antibiotics in a large population of children

• Published in: Pediatric allergy and immunology 2014-02, Vol.25 (1), p.80-87
• Main Authors: Zambonino, Maria A., Corzo, Jose Luis, Muñoz, Candelaria, Requena, Gloria, Ariza, Adriana, Mayorga, Cristobalina, Urda, Antonio, Blanca, Miguel, Torres, M. J.
• Format: Article
• Language: English
• Subjects: Adolescent; Allergies; Amoxicillin - administration & dosage; Amoxicillin - adverse effects; Antibiotics; beta-lactams; beta-Lactams - adverse effects; beta-Lactams - therapeutic use; Cephalosporins - administration & dosage; Cephalosporins - adverse effects; Child; Child, Preschool; children; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - immunology; Drug Hypersensitivity - physiopathology; drug provocation test; Exanthema - diagnosis; Exanthema - immunology; Exanthema - physiopathology; Female; Humans; hypersensitivity; Hypersensitivity, Delayed - diagnosis; Hypersensitivity, Delayed - immunology; Hypersensitivity, Delayed - physiopathology; IgE; Immunization; Immunoglobulin E - blood; Infant; Male; Pediatrics; Population Groups; Side effects; skin test; Skin Tests
• ISSN: 0905-6157; 1399-3038
• DOI: 10.1111/pai.12155

Introduction Hypersensitivity reactions to beta‐lactams (BLs) are often reported in children, with amoxicillin and, to a lesser extent, cephalosporins being the most frequent drugs involved. Although many of these children are considered to be allergic, a careful evaluation only confirms a low percentage. Objectives To analyse the clinical data, sensitization profile and diagnostic methods used in a large group of children with a clinical history of hypersensitivity reactions to BLs. Methods The study included children aged 1–14 yr with symptoms suggestive of hypersensitivity to BLs from January 2006–December 2012. Diagnosis was confirmed from a clinical history, specific IgE determination, skin testing and, if necessary, a drug provocation test (DPT). Results Of a total of 783 patients studied, only 62 (7.92%) were confirmed as being allergic, 9 (14.52%) with immediate and 53 (85.48%) with non‐immediate reactions. In those with immediate reactions, 2 (22.22%) were diagnosed by in vitro test, 2 (22.22%) by skin testing and 5 (55.56%) by DPT; in those with non‐immediate reactions, 2 (3.77%) were diagnosed by skin testing and 51 (96.23%) by DPT. In all cases, DPT was positive to the culprit drug (29 AX‐CLV, 26 AX, 1 cefixime and 1 cefaclor), and the most usual symptoms were exanthema in 43 cases, urticaria in 12, urticaria–angio‐oedema in 1 and erythema in 1 case. Conclusion After an allergological work‐up, over 90% of the children evaluated were finally confirmed as tolerant to BLs. Most reactions were of the non‐immediate type, and DPT was an essential tool for diagnosis.