Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.
Pediatr Allergy Immunol. 2022 Jun;33(6):e13809. doi: 10.1111/pai.13809.
Mild non-immediate reactions (NIR) to beta-lactams (βLs) are the most common manifestation of adverse drug reactions in children, and the drug provocation test (DPT) remains the gold standard for diagnosis. However, there are still controversies about the protocol that should be used, especially regarding the administration of doses and the DPT length.
This study aimed to evaluate a pediatric population with a history of mild NIR to amoxicillin (AMX) or to amoxicillin-clavulanic acid (AMX/CL) who underwent a diagnostic workup including a DPT with the culprit drug, to understand if a graded DPT or, instead, a single full dose could be the most appropriate way of administration in clinical practice.
The data of children were retrospectively analyzed for a 5-year period, with demographic and clinical characteristics collected. We reported the allergy workup and the results of the DPT performed with the administration of incremental doses and a prolonged DPT at home for a total of 5 days.
Three hundred fifty-four patients were included. Overall, 23/354 (6.5%) DPTs were positive: 11/23 patients showed a reaction after 2-8 h after the last dose on the 1st or 2nd day (1 reacted 30 min after the last dose), 1/23 reacted with urticaria 30 min after the first dose, 11/23 reacted at home on the 5th day of the DPT.
This paper indirectly suggests that a single therapeutic dose administered on the 1st day of a DPT could be safe in the diagnostic workup of mild NIR to AMX/CL. Moreover, this could be less time-consuming as patients would spend less time in the hospital, also considering the public health restrictions imposed during the COVID-19 pandemic.
β-内酰胺类（βLs）轻度非即刻反应（NIR）是儿童中最常见的药物不良反应表现，药物激发试验（DPT）仍然是诊断的金标准。然而，关于应该使用哪种方案仍存在争议，特别是在剂量给药和 DPT 持续时间方面。
本研究旨在评估一组曾有轻度阿莫西林（AMX）或阿莫西林克拉维酸（AMX/CL）NIR 病史的儿科人群，他们接受了包括使用致病药物进行 DPT 的诊断性检查，以了解递增剂量 DPT 或单剂全剂量是否更适合临床实践中的给药方式。
回顾性分析了 5 年内儿童的数据，收集了人口统计学和临床特征。我们报告了过敏检查以及在家中使用递增剂量和延长 DPT 共 5 天进行的 DPT 结果。
共纳入 354 例患者。总体而言，23/354（6.5%）的 DPT 呈阳性：11/23 例患者在第 1 或第 2 天的最后一次剂量后 2-8 小时出现反应（1 例在最后一次剂量后 30 分钟出现反应），1/23 例在第 1 次剂量后 30 分钟出现荨麻疹，11/23 例在 DPT 的第 5 天在家中出现反应。
本文间接表明，在 AMX/CL 轻度 NIR 的诊断性检查中，第 1 天给予单剂治疗剂量可能是安全的。此外，由于患者在医院的时间更少，考虑到 COVID-19 大流行期间实施的公共卫生限制，这可能会更节省时间。
