Patterns of response and drugs involved in hypersensitivity reactions to beta-lactams in children
Por:
Torres-Rojas, I, Perez-Alzate, D, Luisa Somoza, M, Haroun Diaz, E, Ruano Perez, F, Prieto-Moreno Pfeifer, A, Jimenez-Rodriguez, T, Fernandez Sanchez, J, Blanca Gomez, M, Canto Diez, G and Blanca-Lopez, N
Publicada:
1 ago 2021
Ahead of Print:
1 ago 2021
Resumen:
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 non-immediate reactions. The workup included sIgE, skin
testing, and drug provocation tests (DPTs) for immediate reactions and
patch testing and DPTs for non-immediate 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 non-immediate 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 non-immediate reactions,
over half of which would also have been lost in a short DPT protocol.
Selective responders to amoxicillin were more likely to have
non-immediate reactions, while clavulanic acid selectivity was exclusive
to the non-immediate typology. Over half the cases with DPTs required
6-7 days of treatment for DHR confirmation.
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