Assessing Pediatric Cephalosporin Allergic Reactions Through Direct Graded Oral Challenges.

Autor:	Sillcox C; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: carly.sillcox@mail.mcgill.ca., Gabrielli S; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada., O'Keefe A; Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada., McCusker C; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada., Abrams EM; Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada., Eiwegger T; Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria; Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria; Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Ont, Canada; Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont, Canada., Atkinson A; Division of Clinical Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont, Canada., Kim V; Division of Clinical Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont, Canada., Copaescu AM; Division of Allergy and Clinical Immunology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia., Ben-Shoshan M; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2024 Jan; Vol. 12 (1), pp. 156-164.e4. Date of Electronic Publication: 2023 Oct 11.
DOI:	10.1016/j.jaip.2023.10.009
Abstrakt:	Background: Cephalosporins, β-lactam antibiotics, commonly cause allergic reactions. Objective: To assess the clinical characteristics and management of pediatric patients with suspected cephalosporin allergy using direct graded oral challenges (GOCs). Methods: Children referred for suspected cephalosporin allergy at 4 Canadian clinics were recruited over 10 years. Data on demographics, clinical reaction characteristics, and management were collected through a questionnaire. Patients underwent a direct GOC (initially 10% of the treatment dose, then 90% after 20 min), and reactions were monitored 1 week postchallenge. Families were contacted annually for up to 5 years to detect subsequent antibiotic reactions. Logistic regression analysis identified factors associated with positive GOC reactions. Results: Among the 136 patients reporting cephalosporin allergy, 75 (55.1%) were males with a median age of 3.9 years (interquartile range 2.3-8.7). Cefprozil represented the most common cephalosporin linked to the index reaction (67.6% of cases). Of the 136 direct GOCs, 5.1% had an immediate and 4.4% a nonimmediate reaction, respectively. Positive GOCs conducted in children with a history of skin-limited nonsevere rashes were classified as mild, benign skin rashes. Positive GOCs were more likely in children with food allergies (adjusted odds ratio 1.14; 95% confidence interval [95% CI] 1.00-1.29). Conclusions: Direct GOCs are safe and effective for diagnosing pediatric cases that report nonvesicular skin-limited symptoms while being treated with cephalosporins. (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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