Prospective assessment of diagnostic tests for pediatric penicillin allergy : From clinical history to challenge tests
Copyright © 2018 American College of Allergy, Asthma 8 Immunology. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use.
OBJECTIVE: To assess the accuracy of tools for diagnosis of penicillin allergy in children.
METHODS: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs).
RESULTS: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007).
CONCLUSION: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:121 |
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| Enthalten in: |
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology - 121(2018), 2 vom: 13. Aug., Seite 235-244.e3 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
37341-29-0 |
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| Anmerkungen: |
Date Completed 08.04.2019 Date Revised 08.04.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.anai.2018.05.013 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM284492671 |
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| 100 | 1 | |a Ibáñez, María Dolores |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prospective assessment of diagnostic tests for pediatric penicillin allergy |b From clinical history to challenge tests |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 08.04.2019 | ||
| 500 | |a Date Revised 08.04.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 American College of Allergy, Asthma 8 Immunology. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use | ||
| 520 | |a OBJECTIVE: To assess the accuracy of tools for diagnosis of penicillin allergy in children | ||
| 520 | |a METHODS: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs) | ||
| 520 | |a RESULTS: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007) | ||
| 520 | |a CONCLUSION: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 650 | 7 | |a Penicillins |2 NLM | |
| 650 | 7 | |a Immunoglobulin E |2 NLM | |
| 650 | 7 | |a 37341-29-0 |2 NLM | |
| 700 | 1 | |a Rodríguez Del Río, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Lasa, Eva Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Joral, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiz-Hornillos, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz, Candelaria |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez Traseira, Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a Escudero, Carmelo |e verfasserin |4 aut | |
| 700 | 1 | |a Olaguibel Rivera, Jose María |e verfasserin |4 aut | |
| 700 | 1 | |a Garriga-Baraut, Teresa |e verfasserin |4 aut | |
| 700 | 1 | |a González-de-Olano, David |e verfasserin |4 aut | |
| 700 | 1 | |a Rosado, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Sanchez-García, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a Pérez Bustamante, Socorro |e verfasserin |4 aut | |
| 700 | 1 | |a Padial Vilchez, Maria Antonia |e verfasserin |4 aut | |
| 700 | 1 | |a Prieto Montaño, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Candón Morillo, Rocío |e verfasserin |4 aut | |
| 700 | 1 | |a Macías Iglesia, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a Feliú Vila, Angélica |e verfasserin |4 aut | |
| 700 | 1 | |a Valbuena, Teresa |e verfasserin |4 aut | |
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| 700 | 1 | |a Sastre, Joaquín |e verfasserin |4 aut | |
| 700 | 1 | |a Audícana, María Teresa |e verfasserin |4 aut | |
| 700 | 0 | |a Penicillin Allergy in Children (APENIN) Task Force. Pediatric Allergy Committee, Spanish Society of Allergy and Clinical Immunology (SEAIC) |e verfasserin |4 aut | |
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