Patterns of response and drugs involved in hypersensitivity reactions to beta-lactams in children
| Autor: | Isabel Torres-Rojas, Gabriela Canto Díez, Elisa Haroun Diaz, Teodorikez Wilfox Jimenez-Rodriguez, Maria Luisa Somoza, Javier Fernandez Sánchez, Francisco Javier Ruano Pérez, Natalia Blanca-López, Ana María Prieto-Moreno Pfeifer, Miguel Blanca, Diana Pérez-Alzate |
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| Rok vydání: | 2021 |
| Předmět: |
Drug
Hypersensitivity Immediate medicine.medical_specialty medicine.drug_class media_common.quotation_subject Immunology Provocation test Cephalosporin Immunoglobulin E beta-Lactams Drug Hypersensitivity Clavulanic acid Immunology and Allergy Medicine Humans Prospective Studies Prospective cohort study Child media_common Skin Tests biology business.industry Amoxicillin Dermatology Anti-Bacterial Agents Penicillin Pharmaceutical Preparations Pediatrics Perinatology and Child Health biology.protein business medicine.drug |
| Zdroj: | Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and ImmunologyREFERENCES. 32(8) |
| ISSN: | 1399-3038 |
| Popis: | Background Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. Methods Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and nonimmediate reactions. The work-up included sIgE, skin testing and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for nonimmediate ones. Results Of the 510 children included, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%). Among nonimmediate reactions (11,4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6-7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities. Conclusions There were few confirmed cases of either type of reaction. Skin testing proved less valuable in nonimmediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have nonimmediate reactions, while clavulanic acid-selectivity was exclusive to the nonimmediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation. |
| Databáze: | OpenAIRE |
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