The use of in vivo and in vitro tests in children with beta lactam allergy
Main Article Content
Keywords
Beta-lactam, Drug allergy, Drug hypersensitivity, Antibiotic allergy, Immediate reactions
Abstract
Background: Drug allergies are reactions within the context of drug hypersensitivity reactions, which are caused by immunological mechanisms due to a previously sensitising drug. Beta-lactam antibiotics (BLA) are the leading agents causing drug hypersensitivity reactions in children.
The aim of this study is to evaluate the diagnostic importance of in vivo and in vitro diagnostic tests in children with suspected immediate-type BLA hypersensitivity and to investigate the frequency of their use for the final diagnosis.
Methods: Patients admitted to the Outpatient Clinic of Division of Paediatric Allergy and Immunology with suspicion of immediate-type BLA hypersensitivity between December 2014 and December 2018 were investigated. Patients with a history of immediate reactions to BLA were examined by performing drug specific IgE, skin prick tests, intradermal tests and drug provocation tests (DPT).
Results: During the study period, 148 patients were admitted to our clinic with suspected immediate-type BLA hypersensitivity. Forty-eight patients completed all assessment steps and were enrolled in the study. It has been shown that 27 patients did not have drug allergy. BLA hypersensitivity was proven in 21 patients by using in vivo test algorithm. More than half of the patients were diagnosed via skin tests with culprit drug.
Conclusion: Allergy work-up should be performed in patients with immediate reactions to BLA. A skin test can demonstrate BLA hypersensitivity in most patients. Thus, skin tests should be performed prior to the drug provocation test.
References
2. Blanca M, Romano A, Torres MJ, Férnandez J, Mayorga C, Rodriguez J, et al. Update on the evaluation of hypersensitivity reactions to beta-lactams. Allergy. 2009;64:183---93.
3. Messaad D, Sahla H, Benahmed S, Godard P, Bousquet J, Demoly P. Drug provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann Intern Med. 2004;140:1001---6.
4. Mittmann N, Knowles SR, Gomez M, Fish JS, Cartotto R, Shear NH. Evaluation of The extent of under-reporting of serious adverse drug reactions: the case of toxic epidermal necrolysis. Drug Saf. 2004;27:477---87.
5. Solensky R. Hypersensitivity reactions to beta-lactam antibiotics. Clin Rev Allergy Immunol. 2003;24:201---19.
6. Sogn DD, Evans R 3rd, Shepherd GM, Casale TB, Condemi J, Greenberger PA, et al. Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Arch Intern Med. 1992;152:1025---32.
7. Empedrad R, Darter AL, Earl HS, Gruchalla RS. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol. 2003;112:629---30.
8. Atanaskovic-Markovic M, Gaeta F, Medjo B, Gavrovic-Jankulovic M, Cirkovic Velickovic T, Tmusic V, et al. Non-immediate hypersensitivity reactions to beta-lactam antibiotics in children --- our
10-year experience in allergy work-up. Pediatr Allergy Immunol. 2016;27:533---8.
9. Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, BlancaLopez, et al. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy. 2016;71:149---61.
10. Parker C, Deweck A, Kern M, Eisen H. The preparation and some properties of penicillenic acid derivatives relevant to penicillin hypersensitivity. J Exp Med. 1962;115:803---19.
11. Levine BB, Redmond AP. Minor haptenic determinant-specific reagins of penicillin hypersensitivity in man. Int Arch Allergy Appl Immunol. 1969;35:445---55.
12. Solensky R. Drug hypersensitivity. Med Clin N Am. 2006;90:233---60.
13. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M,
Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs --- an ENDA/EAACI Drug Allergy Interest
Group position paper. Allergy. 2013;68:702---12.
14. Torres MJ, Blanca M. The complex clinical picture of betalactam hypersensitivity: penicillins, cephalosporins, monobactams, carbapenems, and clavams. Med Clin North Am.
2010;94:805---20.
15. Misirlioglu ED, Guvenir H, Toyran M, Vezir E, Capanoglu M, Civelek E, et al. Frequency of selective immediate responders to aminopenicillins and cephalosporins in Turkish children. Allergy Asthma Proc. 2017;38:376---82.
16. Graham F, Tsabouri S, Caubet JC. Hypersensitivity reactions to beta-lactams in children. Curr Opin Allergy Clin Immunol. 2018;18:284---90.
17. Vila L, Garcia V, Martinez Azcona O, Pineiro L, Meijide A, Balboa V. Mild to moderate hypersensitivity reactions to beta-lactams in children: a single-centre retrospective review. BMJ Paediatr Open. 2019:3, http://dx.doi.org/10.1136/bmjpo-2019-000435.
18. Azevedo J, Gaspar Â, Mota I, Benito-Garcia F, Alves-Correia M, Chambel M, et al. Anaphylaxis to beta-lactam antibiotics at pediatric age: six-year survey. Allergol Immunopathol (Madr). 2019;47:128---32.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.