Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Division of Pediatric Allergy and Immunology, Department of Pediatrics, SBU Istanbul Cemil Tascioglu City Hospital, Istanbul, Turkey.
Int Arch Allergy Immunol. 2023;184(6):539-549. doi: 10.1159/000529084. Epub 2023 Mar 1.
Beta-lactam (BL) antibiotics are the most often involved drugs in allergic reactions. Mild cutaneous reactions such as maculopapular exanthema or urticaria are the most common presenting complaints of BL allergy in the pediatric population. However, it can be challenging to distinguish BL-induced allergy from reactions due to infections or other reasons. In this study, we aimed to determine the clinical characteristics and potential risk factors of true BL allergy in children with suspected mild cutaneous reactions to BLs.
We evaluated children who were admitted to our pediatric allergy clinic with suspected BL allergy in between January 2015 and March 2020. Patients with a history suggestive of immediate and non-immediate mild cutaneous reactions were included in the study. The oral challenge test (OCT) with the culprit drug was performed on all patients to confirm the diagnosis.
Two hundred fourteen (119 male and 95 female) patients with a median age of 4.9 years were evaluated. BL allergy was confirmed in 10.7% (23) of the patients, according to the OCT results. Most of the proven allergic reactions were of the immediate type (73.9%), and urticaria was the most common presenting complaint (60.8%) in proven BL-allergic patients. The negative predictive value of penicillin-G skin testing was 89.7% for immediate-type penicillin allergy and 93.4% for non-immediate reactions. Also, positive predictive value of penicillin-G skin testing was 50% for immediate and 25% for non-immediate reactions. In the multivariate logistic regression analysis, a history of proven drug allergy (Exp (B): 7.76, 95% CI: 1.88-31.97, p = 0.005) was found to be the risk for BL allergy.
This study highlighted that OCTs should be performed to confirm the diagnosis in patients suspected of immediate and non-immediate mild cutaneous reactions to BLs and remove the overestimated "BL allergy" label. In these patients, a history of proven drug allergy might be a risk factor for true BL allergy.
β-内酰胺（BL）类抗生素是最常涉及的过敏反应药物。在儿科人群中，BL 过敏的最常见表现为斑丘疹性发疹或荨麻疹等轻度皮肤反应。然而，区分 BL 诱导的过敏反应与感染或其他原因引起的反应具有挑战性。在这项研究中，我们旨在确定疑似 BL 类药物引起的轻度皮肤反应患儿中真正 BL 过敏的临床特征和潜在危险因素。
我们评估了 2015 年 1 月至 2020 年 3 月期间因疑似 BL 过敏而在我院儿科过敏门诊就诊的患儿。纳入研究的患儿有明确的即刻和非即刻轻度皮肤反应病史。所有患者均进行了可疑药物的口服激发试验（OCT）以明确诊断。
共评估了 214 名（男 119 名，女 95 名）中位年龄为 4.9 岁的患儿。根据 OCT 结果，23 名（10.7%）患儿被确诊为 BL 过敏。大多数已证实的过敏反应为即刻型（73.9%），且已证实的 BL 过敏患者中最常见的表现为荨麻疹（60.8%）。青霉素 G 皮试对即刻型青霉素过敏的阴性预测值为 89.7%，对非即刻反应的阴性预测值为 93.4%。此外，青霉素 G 皮试的阳性预测值对于即刻型反应为 50%，对于非即刻型反应为 25%。在多变量逻辑回归分析中，有已证实的药物过敏史（Exp（B）：7.76，95%CI：1.88-31.97，p=0.005）被发现是 BL 过敏的危险因素。
本研究强调，对于疑似 BL 类药物引起的即刻和非即刻轻度皮肤反应的患者，应进行 OCT 以明确诊断，并消除对 BL 过敏的过高“BL 过敏”标签。在这些患者中，已证实的药物过敏史可能是真正 BL 过敏的危险因素。
