Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain.
Hospital Regional Universitario de Málaga, Malaga, Spain.
Pediatr Allergy Immunol. 2024 Mar;35(3):e14096. doi: 10.1111/pai.14096.
Allergy to beta-lactam antibiotics (BLA) is frequently suspected in children, but a drug provocation test (DPT) rules it out in over 90% of cases. Direct oral DPT (DODPT), without skin or other previous tests, is increasingly been used to delabel non-immediate BLA reactions. This real-world study aimed to assess the safety and effectiveness of DODPT in children with immediate and non-immediate reactions to BLAs.
Ambispective registry study in children (<15 years), attended between 2016 and 2023 for suspected BLA allergy in 15 hospitals in Spain that routinely perform DODPT.
The study included 2133 patients with generally mild reactions (anaphylaxis 0.7%). Drug provocation test with the implicated BLA was performed in 2014 patients (94.4%): 1854 underwent DODPT (86.9%, including 172 patients with immediate reactions). One hundred forty-five (7.2%) had symptoms associated with DPT, although only four reactions were severe: two episodes of anaphylaxis and two of drug-induced enterocolitis syndrome, which resolved rapidly with treatment. Of the 141 patients with mild reactions in the first DPT, a second DPT was considered in 87 and performed in 57, with 52 tolerating it without symptoms. Finally, BLA allergy was ruled out in 90.9% of the sample, confirmed in 3.4%, and remained unverified, usually due to loss to follow-up, in 5.8%.
Direct oral DPT is a safe, effective procedure even in immediate mild reactions to BLA. Many reactions observed in DPT are doubtful and require confirmation. Severe reactions are exceptional and amenable to treatment. Direct oral DPT can be considered for BLA allergy delabeling in pediatric primary care.
儿童中经常怀疑对β-内酰胺抗生素（BLA）过敏，但药物激发试验（DPT）在超过 90%的病例中排除了这种情况。直接口服 DPT（DODPT），无需皮肤或其他先前的测试，越来越多地用于去除非即刻 BLA 反应的标签。这项真实世界的研究旨在评估 DODPT 在对 BLA 有即刻和非即刻反应的儿童中的安全性和有效性。
这是一项在西班牙 15 家医院进行的前瞻性登记研究，这些医院在 2016 年至 2023 年间常规进行 DODPT，以评估疑似 BLA 过敏的儿童。
该研究纳入了 2133 名有一般轻度反应（过敏反应 0.7%）的患者。对 2014 名患者进行了有可疑 BLA 的药物激发试验（94.4%）：1854 名患者进行了 DODPT（86.9%，包括 172 名有即刻反应的患者）。145 名（7.2%）患者在 DPT 期间出现了与 DPT 相关的症状，但只有 4 例反应严重：2 例过敏反应和 2 例药物诱导性肠炎综合征，经治疗迅速缓解。在首次 DPT 中有轻度反应的 141 名患者中，87 名考虑进行第二次 DPT，57 名进行了第二次 DPT，其中 52 名无症状耐受。最后，在样本中 90.9%的患者排除了 BLA 过敏，3.4%的患者得到了确认，5.8%的患者仍未得到证实，通常是因为失去了随访。
即使在对 BLA 有即刻轻度反应的情况下，直接口服 DPT 也是一种安全有效的方法。在 DPT 中观察到的许多反应是可疑的，需要确认。严重反应是罕见的，并且可以治疗。直接口服 DPT 可考虑用于儿科初级保健中 BLA 过敏的标签去除。
