Prospective assessment of diagnostic tests for pediatric penicillin allergy From clinical history to challenge tests

被引：69

作者：

Dolores Ibanez, Maria ^{[1
,2
]}

Rodriguez del Rio, Pablo ^{[1
,2
]}

Maria Lasa, Eva ^{[3
]}

Joral, Alejandro ^{[3
]}

Ruiz-Hornillos, Javier ^{[4
,5
]}

Munoz, Candelaria ^{[6
]}

Gomez Traseira, Carmen ^{[7
]}

Escudero, Carmelo ^{[1
,2
]}

Olaguibel Rivera, Jose Maria ^{[8
]}

Garriga-Baraut, Teresa ^{[9
,10
]}

Gonzalez-de-Olano, David ^{[11
]}

Rosado, Ana ^{[12
]}

Sanchez-Garcia, Silvia ^{[1
,2
]}

Perez Bustamante, Socorro ^{[13
,14
]}

Padial Vilchez, Maria Antonia ^{[15
]}

Prieto Montano, Patricia ^{[16
]}

Candon Morillo, Rocio ^{[17
]}

Macias Iglesia, Eva ^{[18
]}

Felin Vila, Angelica ^{[19
]}

Valbuena, Teresa ^{[15
]}

Lopez-Patino, Ana ^{[20
]}

Martorell, Antonio ^{[21
]}

Sastre, Joaquin ^{[5
,22
,23
]}

Teresa Audicana, Maria ^{[24
]}

机构：

[1] Nino Jesus Univ Childrens Hosp, Dept Allergy, Madrid, Spain

[2] Res Network ARADyAL RD16 0006 0026, Madrid, Spain

[3] Hosp Univ Donostia, Dept Allergy, Guipuzcoa, Spain

[4] Hosp Univ Infanta Elena, Dept Allergy, Valdemoro, Spain

[5] Fdn Jimenez Diaz, Inst Invest Sanitaria, Madrid, Spain

[6] Univ Reg Hosp, Allergy Dept, Children Hosp, Malaga, Spain

[7] Hosp La Paz, Inst Hlth Res, Dept Allergy, Madrid, Spain

[8] Complejo Hosp Navarra, Serv Alergol, Pamplona, Spain

[9] Hosp Univ Vall dHebron, Unitat Allergol Pediat, Barcelona, Spain

[10] Inst Recerca Vall dHebron, Grp Creixement & Desenvolupament, Barcelona, Spain

[11] Hosp Univ Fuenlabrada, Allergy Unit, Madrid, Spain

[12] Hosp Univ Fdn Alcorcon, Unidad Alergia, Madrid, Spain

[13] Torrejon Univ Hosp, Dept Allergy, Madrid, Spain

[14] Rincon Hlth Grp, Dept Allergy, Malaga, Spain

[15] Hosp Infanta Sofia, Serv Alergol, SS Reyes, Madrid, Spain

[16] Complejo Hosp Univ Albacete, Serv Alergol, Albacete, Spain

[17] Hosp Gen La Mancha Ctr, Dept Allergy, Ciudad Real, Spain

[18] Complejo Asistencial Univ Salamanca, Dept Allergy, Salamanca, Spain

[19] Hosp Tajo, Dept Allergy, Aranjuez, Spain

[20] Xarxa Santa Tecla, Allergy Unit, Tarragona, Spain

[21] Univ Gen Hosp, Dept Allergy, Valencia, Spain

[22] Fdn Jimenez Diaz, Dept Allergy, Madrid, Spain

[23] Fac Univ Autonoma Madrid, Madrid, Spain

[24] HUA, Dept Allergy, Inst Bioaraba, Vitoria, Spain

来源：

ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY | 2018年 / 121卷 / 02期

关键词：

BETA-LACTAM ANTIBIOTICS; DRUG ALLERGY; HYPERSENSITIVITY REACTIONS; CHILDREN; MANAGEMENT; SKIN; SYMPTOMS;

D O I：

10.1016/j.anai.2018.05.013

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

Background: Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use. Objective: To assess the accuracy of tools for diagnosis of penicillin allergy in children. Methods: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs). Results: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007). Conclusion: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children. (C) 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

引用

页码：235 / +

页数：13

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