Allergy to beta-lactam antibiotics in children: Risk factors for a positive diagnostic work-up |
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| Affiliation: | 1. Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, Porto, Portugal;2. MedInUP – Center for Drug Discover and Innovative Medicines, Faculty of Medicine, University of Porto, Porto, Portugal;3. Public Health and Forensic Sciences and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal;4. UNIC – Cardiovascular Research and Development Unit, University of Porto, Porto, Portugal;5. Biomedicine Department, Faculty of Medicine, University of Porto, Porto, Portugal;6. I3S – Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal;1. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;2. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;3. Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts;4. The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts;5. Harvard Medical School, Boston, Massachusetts;7. Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts;11. Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts;1. The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310006, China;2. Experimental Animal centre, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang, 310013, China;1. Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan;2. Department of Pediatrics, Saitama Red Cross Hospital, Saitama 330-8553, Japan;1. Clinical and Chemical Pathology Department, National Research Center, Egypt;2. Molecular Genetics and Enzymology Department, National Research Center, Egypt;3. Pediatric Department, Cairo University, Egypt;1. College of Medical technology MTI- BKMC Mardan, Khyber Pakhtunkhwa, Pakistan;2. Rehman College of Allied Health Sciences, Peshawar, Khyber Pakhtunkhwa, Pakistan;3. North West General Hospital and Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan;1. Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia;2. Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia;3. Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia |
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| Abstract: | ![]()
BackgroundAllergy to beta-lactam (βL) antibiotics is highly reported in children, but rarely confirmed. Risk factors for a positive diagnostic work-up are scarce.The primary aim was to characterize the cases of children with confirmed βL allergy, investigating potential risk factors. Secondary aims were to assess the prevalence of allergy to βL in this population and to confirm the safety of less extensive diagnostic protocols for milder reactions.MethodsWe reviewed the clinical data from all children evaluated in our Department for suspected βL allergy, over a six-year period.ResultsTwo hundred and twenty children (53% females) with a mean age of 6.5 ± 4.2 years were evaluated. Cutaneous manifestations were the most frequently reported (96.9%), mainly maculopapular exanthema (MPE). The reactions were non-immediate in 59.5% of the cases.Only 23 children (10.5%) were diagnosed with allergy to βL. The likelihood of βL allergy was significantly higher in children with a family history of drug allergy (p < 0.001) and in those with a smaller time period between the reaction and the study (p = 0.046). The probability of not confirming βL allergy is greater in children reporting less severe reactions (p < 0.001) and MPE (p < 0.001).We found the less extensive diagnostic protocol in milder reactions safe, since only 4.2% of the children presented a positive provocation test (similar reaction as the index reaction).ConclusionThis study highlights family history of drug allergy as a risk factor for a positive diagnostic work-up. Larger series are required, particularly genetic studies to accurately determine future risk for βL allergy in children. |
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| Keywords: | Drug allergy Beta-lactam antibiotics Children Allergy diagnostic work-up Risk factors |
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