Arnold Annabelle, Sommerfield Aine, Ramgolam Anoop, Rueter Kristina, Muthusamy Saravanan, Noble Valerie, von Ungern-Sternberg Britta S, Lucas Michaela
Department of Paediatric Immunology, Perth Children's Hospital, Perth, Western Australia, Australia.
Telethon Kids Institute, Perth, Western Australia, Australia.
J Paediatr Child Health. 2019 Apr;55(4):428-432. doi: 10.1111/jpc.14220. Epub 2018 Sep 13.
To determine if skin testing (ST) in addition to extended oral provocation challenge (OPC) is necessary for beta-lactam allergy verification in an Australian paediatric population.
This was a retrospective study (176 children) that undertook assessments for beta-lactam allergy from 2006 to 2015 at a tertiary paediatric hospital. Patients either underwent direct OPC without ST or ST plus challenge if ST was negative.
The analysis included children with a history of varying rash types/severity as well as angioedema and reported anaphylaxis. A direct OPC was undertaken in 73 children. Three children reacted with one anaphylaxis. A total of 103 children underwent ST, with 13 children (12.6%) reacting. Of the 90 who subsequently proceeded to OPC, 4 reacted. A total of 132 children were given an extended oral course of the culprit antibiotic, to which 6 children reacted.
A direct OPC with the culprit drug in Australian children can be safely performed, avoiding resource-intensive and painful ST. Our data demonstrate that a prior history of anaphylaxis does not necessarily predict IgE-mediated allergy, as detected by positive immediate ST or reactions to oral challenge. Such history should not detract from efforts to assess these children for antibiotic allergy. We suggest that extended courses of at least 5 days are important in paediatric antibiotic de-labelling as six children (4.5% of those who were prescribed the extended course) reacted in our study and even developed symptoms late in the extended course, from days 2 to 6.
确定在澳大利亚儿科人群中，除了延长口服激发试验（OPC）外，皮肤试验（ST）对于β-内酰胺类过敏验证是否必要。
这是一项回顾性研究（176名儿童），于2006年至2015年在一家三级儿科医院对β-内酰胺类过敏进行评估。患者要么直接接受无ST的OPC，要么在ST为阴性时接受ST加激发试验。
分析纳入了有不同皮疹类型/严重程度以及血管性水肿和报告的过敏反应病史的儿童。73名儿童接受了直接OPC。3名儿童出现反应，其中1名发生过敏反应。共有103名儿童接受了ST，13名儿童（12.6%）出现反应。在随后进行OPC的90名儿童中，4名出现反应。共有132名儿童接受了可疑抗生素的延长口服疗程，6名儿童出现反应。
在澳大利亚儿童中，可以安全地进行使用可疑药物的直接OPC，避免资源密集且痛苦的ST。我们的数据表明，过敏反应的既往史不一定能预测IgE介导的过敏，如通过即时ST阳性或口服激发试验反应所检测到的。这样的病史不应妨碍对这些儿童进行抗生素过敏评估的努力。我们建议，至少5天的延长疗程在儿科抗生素去标签中很重要，因为在我们的研究中有6名儿童（接受延长疗程者的4.5%）出现反应，甚至在延长疗程后期（第2至6天）出现症状。
