Safety of direct oral provocation testing using the Amoxicillin-2-step-challenge in children with history of non-immediate reactions to amoxicillin
| Autor: | Araya Yuenyongviwat, Duangdee Wantanaset, Vanlaya Koosakulchai, Pasuree Sangsupawanich, Pondtip Jongvilaikasem, Wipa Jessadapakorn |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Drug medicine.medical_specialty Amoxicillin hypersensitivity medicine.drug_class medicine.medical_treatment media_common.quotation_subject Immunology Antibiotics Provocation test Culprit Article medicine Immunology and Allergy media_common Angioedema business.industry Non-immediate reactions RC581-607 Amoxicillin Rash Dermatology Drug provocation test Antihistamine Immunologic diseases. Allergy medicine.symptom business medicine.drug |
| Zdroj: | The World Allergy Organization Journal World Allergy Organization Journal, Vol 14, Iss 7, Pp 100560-(2021) |
| ISSN: | 1939-4551 |
| Popis: | Background Previous studies have shown that direct oral provocation tests, without prior skin testing, in children having delayed onset, benign rashes to beta-lactam antibiotic is safe and effective. Although, this test is useful in confirming drug hypersensitivity reactions, there is no standard protocol recommendation of drug provocation tests. This study aimed to evaluate the safety of the direct oral provocation test, using the Amoxicillin-2-step-challenge without prior skin testing, in children with history of non-immediate reactions to amoxicillin. Methods The Amoxicillin-2-step-challenge protocol was performed in children with history of non-immediate reactions to amoxicillin. This protocol is composed of 2 doses of amoxicillin, with a 30-min interval; continued for a total of 5 days. All of the patients had not undergone skin testing before the oral provocation test. Results This study included 54 children, having a median age of 6.6 years, with 70.4% being male. Amoxicillin and amoxicillin-clavulanic acid were reported as the culprit drug in 75.9% and 24.1%, respectively. The index reactions were maculopapular (MP) rash in 79.6% and delayed urticarial rash/angioedema in 20.4%. Five patients (9.3%) had a reaction during the provocation test, all of these patients had delayed urticaria and were treated with oral antihistamine. However, 1 patient developed a fever alongside an MP rash. Laboratory investigation for this patient showed increased atypical lymphocytes and liver enzymes elevation. Conclusions Direct oral provocation tests, using the Amoxicillin-2-step-challenge, without prior skin testing, revealed good, immediate safety for the diagnosis of amoxicillin hypersensitivity in children with history of non-immediate reactions to amoxicillin. |
| Databáze: | OpenAIRE |
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