Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Allergy and Clinical Immunology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1673-1680. doi: 10.1016/j.jaip.2018.01.030. Epub 2018 Feb 7.
Penicillin allergy is the most frequent drug allergy, among which aminopenicillins are reputed for causing delayed rashes in children, particularly in the context of viral infections. Despite a negative allergy evaluation, a significant proportion of individuals continue to avoid penicillin antibiotics for fear of an allergic reaction.
To evaluate the safety and efficacy of a 5-day challenge to amoxicillin and the proportion of subsequent use of amoxicillin.
Pediatric patients with a history of a reaction to amoxicillin were prospectively recruited in the study. All patients were challenged, and those with negative immediate challenges underwent an ambulatory 5-day challenge to amoxicillin to rule out nonimmediate reactions. Patients were called 2 years after their initial allergy evaluation to assess subsequent amoxicillin use and tolerance.
One hundred thirty children with a history of amoxicillin allergy underwent a graded drug provocation test (DPT) to amoxicillin. Three patients had a positive immediate challenge, 3 had a positive nonimmediate challenge, and 2 were equivocal. Of the 122 patients with a negative challenge, 114 (93.4%) were reached 2 years after their initial allergy evaluation: 75 had used antibiotics since, of which only 1 (1.3%) had refused to reuse amoxicillin because of fear of an allergic reaction. Finally, the 5-day DPT resulted in a 24.1% decrease in future penicillin avoidance compared with classical single-dose graded DPT performed for 1 day in a historical cohort (P < .0001).
The 5-day challenge is a safe and effective way to rule out nonimmediate amoxicillin allergy, and it ensures better compliance with future penicillin use.
青霉素过敏是最常见的药物过敏，其中氨基青霉素类药物据称会在儿童中引起迟发性皮疹，尤其是在病毒感染的情况下。尽管进行了过敏评估，但仍有相当一部分人因担心过敏反应而继续避免使用青霉素类抗生素。
评估 5 天阿莫西林挑战的安全性和疗效，以及随后使用阿莫西林的比例。
前瞻性招募有阿莫西林过敏反应史的儿科患者。所有患者均进行了挑战，即时挑战阴性的患者进行了 5 天的门诊阿莫西林挑战，以排除非即时反应。在最初过敏评估后的 2 年对患者进行随访，以评估随后使用阿莫西林的情况和耐受性。
130 例有阿莫西林过敏史的儿童进行了分级药物激发试验（DPT）。3 例患者即时挑战阳性，3 例患者非即时挑战阳性，2 例结果不确定。在 122 例阴性挑战的患者中，有 114 例（93.4%）在最初过敏评估后 2 年得到随访：其中 75 例使用过抗生素，其中只有 1 例（1.3%）因担心过敏反应而拒绝再次使用阿莫西林。最终，与历史队列中进行的 1 天单剂量分级 DPT 相比，5 天 DPT 导致未来避免使用青霉素的比例降低了 24.1%（P<0.0001）。
5 天挑战是排除非即时阿莫西林过敏的安全有效方法，可确保更好地遵循未来使用青霉素的建议。
