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Is an extensive allergy diagnosis workup needed in all cases of suspected hypersensitivity to beta-lactams in children?

Is an extensive allergy diagnosis workup needed in all cases of suspected hypersensitivity to... de Castro et al. Clinical and Translational Allergy 2014, 4(Suppl 3):P141 http://www.ctajournal.com/content/4/S3/P141 POSTER PRESENTATION Open Access Is an extensive allergy diagnosis workup needed in all cases of suspected hypersensitivity to beta-lactams in children? Eunice Dias de Castro , Fabrícia Carolino, Josefina Rodrigues Cernadas From 6th Drug Hypersensitivity Meeting (DHM 6) Bern, Switzerland. 9-12 April 2014 Introduction suspected drug; 15 children had previous exposure with Beta-lactams (BL) are one of the most prescribed antibio- a similar reaction. In the group of patients with immediate tics (AB) class. They are frequently implicated in hyper- reactions or unknown time of onset (n=49), determination sensitivity reactions (HSR), with common skin of specific IgE (sIgE) for penicillin G, V and amoxicillin involvement. However, infectious conditions might also was performed in 43 (87.8%), and skin prick tests in 42 induce cutaneous lesions, especially in children, and they patients (85.7%), all with negative results. Of all patients, constitute an important differential diagnosis to BL HSR. 16 (20%) underwent intradermal testing (IDT) and only one patient had a positive result with PPL 1/1; late reading Aims was done in 3 cases, all negative. Oral provocation test To characterize suspected BL HSR and analyse the (OPT) with the suspected BL (single or continued at prevalence of allergic reactions in our study population. home) was performed in 74 cases (89.2%) with positive result in 6 patients (8.1%), all of them exclusively with late Methods cutaneous involvement. We retrospectively reviewed the clinical data from all children (<18 years-old) referred to our Allergology Discussion Department for suspected BL HSR between 2011 and Suspected BL HSR was only confirmed in 8.1%. 2013. Although MPE caused by BL treatment in children is rare, there are no clinical distinctive characteristics from Results MPE related to infections, making allergy diagnosis Eighty children (56.2% females) with a mean age of workup mandatory. The authors raise the question of 6.7 yrs (SD=4.035) where evaluated for 83 suspected BL the need of sIgE determination and skin testing in less HSR. The mean time elapsed between the reaction severe reactions, instead of performing directly the OPT. and the clinical assessment was of 3.1 yrs (SD=3.36). The most frequently implicated drugs were amoxicillin/ Published: 18 July 2014 clavulanate (54.2%) and amoxicillin (32.5%). BL were prescribed for tonsillitis in 32.5%, otitis in 21.7% and upper airways infection in 19.3%. Cutaneous lesions doi:10.1186/2045-7022-4-S3-P141 were the most frequently reported (94%) manifestations, Cite this article as: de Castro et al.: Is an extensive allergy diagnosis with maculopapular exanthema (MPE) being the most workup needed in all cases of suspected hypersensitivity to beta- lactams in children? Clinical and Translational Allergy 2014 4(Suppl 3):P141. common. In 45 reactions (54.2%), the time of onset was unknown; in 4.8% the reaction was immediate and in the remaining cases non immediate (41%). In 23 cases (27.7%) there was no history of previous exposure to the CH São João, Immunoallergology Department, Portugal © 2014 de Castro et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical and Translational Allergy Springer Journals

Is an extensive allergy diagnosis workup needed in all cases of suspected hypersensitivity to beta-lactams in children?

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Publisher
Springer Journals
Copyright
Copyright © 2014 by de Castro et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; Allergology; Immunology
eISSN
2045-7022
DOI
10.1186/2045-7022-4-S3-P141
Publisher site
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Abstract

de Castro et al. Clinical and Translational Allergy 2014, 4(Suppl 3):P141 http://www.ctajournal.com/content/4/S3/P141 POSTER PRESENTATION Open Access Is an extensive allergy diagnosis workup needed in all cases of suspected hypersensitivity to beta-lactams in children? Eunice Dias de Castro , Fabrícia Carolino, Josefina Rodrigues Cernadas From 6th Drug Hypersensitivity Meeting (DHM 6) Bern, Switzerland. 9-12 April 2014 Introduction suspected drug; 15 children had previous exposure with Beta-lactams (BL) are one of the most prescribed antibio- a similar reaction. In the group of patients with immediate tics (AB) class. They are frequently implicated in hyper- reactions or unknown time of onset (n=49), determination sensitivity reactions (HSR), with common skin of specific IgE (sIgE) for penicillin G, V and amoxicillin involvement. However, infectious conditions might also was performed in 43 (87.8%), and skin prick tests in 42 induce cutaneous lesions, especially in children, and they patients (85.7%), all with negative results. Of all patients, constitute an important differential diagnosis to BL HSR. 16 (20%) underwent intradermal testing (IDT) and only one patient had a positive result with PPL 1/1; late reading Aims was done in 3 cases, all negative. Oral provocation test To characterize suspected BL HSR and analyse the (OPT) with the suspected BL (single or continued at prevalence of allergic reactions in our study population. home) was performed in 74 cases (89.2%) with positive result in 6 patients (8.1%), all of them exclusively with late Methods cutaneous involvement. We retrospectively reviewed the clinical data from all children (<18 years-old) referred to our Allergology Discussion Department for suspected BL HSR between 2011 and Suspected BL HSR was only confirmed in 8.1%. 2013. Although MPE caused by BL treatment in children is rare, there are no clinical distinctive characteristics from Results MPE related to infections, making allergy diagnosis Eighty children (56.2% females) with a mean age of workup mandatory. The authors raise the question of 6.7 yrs (SD=4.035) where evaluated for 83 suspected BL the need of sIgE determination and skin testing in less HSR. The mean time elapsed between the reaction severe reactions, instead of performing directly the OPT. and the clinical assessment was of 3.1 yrs (SD=3.36). The most frequently implicated drugs were amoxicillin/ Published: 18 July 2014 clavulanate (54.2%) and amoxicillin (32.5%). BL were prescribed for tonsillitis in 32.5%, otitis in 21.7% and upper airways infection in 19.3%. Cutaneous lesions doi:10.1186/2045-7022-4-S3-P141 were the most frequently reported (94%) manifestations, Cite this article as: de Castro et al.: Is an extensive allergy diagnosis with maculopapular exanthema (MPE) being the most workup needed in all cases of suspected hypersensitivity to beta- lactams in children? Clinical and Translational Allergy 2014 4(Suppl 3):P141. common. In 45 reactions (54.2%), the time of onset was unknown; in 4.8% the reaction was immediate and in the remaining cases non immediate (41%). In 23 cases (27.7%) there was no history of previous exposure to the CH São João, Immunoallergology Department, Portugal © 2014 de Castro et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Journal

Clinical and Translational Allergy – Springer Journals

Published: Jul 18, 2014

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