Department of Clinical Immunology, Perth Children's Hospital, Perth, WA, Australia; UWA Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, WA, Australia; Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Immunology, Sir Charles Gardiner Hospital, Perth, WA, Australia.
Department of Anaesthesia & Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, the University of Western Australia, Perth, WA, Australia; Institute for Pediatric Perioperative Excellence, the University of Western Australia, Perth, WA, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA, Australia.
J Allergy Clin Immunol Pract. 2024 Nov;12(11):3034-3043.e20. doi: 10.1016/j.jaip.2024.08.023. Epub 2024 Aug 20.
There is a scarcity of prospective studies investigating the relative roles of skin prick and intradermal testing, serum specific IgE, and extended oral challenges in diagnosing children with reported β-lactam allergies.
To determine the sensitivity and specificity of skin testing and serum specific IgE in children with β-lactam allergies, with immediate and nonimmediate historic reactions.
Four hundred children with parent-reported β-lactam allergies were recruited into an open-label prospective study. Detailed allergy histories were collected. Those with medically observed and documented histories of anaphylaxis, requiring epinephrine, or severe cutaneous adverse reactions were excluded. In total, 380 children underwent all testing modalities and a direct provocation test. Each child was followed up for a minimum of 3 years.
True allergy in children was uncommon; 8.3% reacted to the direct provocation challenge or the 5-day extended oral provocation challenge. Children reporting cephalosporin allergy or a reaction within 1 year were more likely to react to direct provocation testing. The sensitivity, specificity, and positive predictive value of skin testing were 12.5%, 98.8%, and 20.0% for direct challenge outcomes, 4.76%, 99.0%, and 25.0% for extended challenge outcomes, and 6.9%, 99.0%, and 40.0% for both challenges combined, respectively. Follow-up investigations revealed that 5.7% of children had a mild repeat reaction and 2.7% continued to avoid the culprit despite successful delabeling. The relabeling rate for children readmitted to hospital was 15%, with the relabeing being unfounded.
Genuine β-lactam allergies were rare, with over 90% of children effectively delabeled. Skin and serum specific IgE testing did not aid the diagnosis of β-lactam antibiotic allergy in children, regardless of medical history. Extended oral challenges proved valuable in confirming allergies and boosted parental confidence.
缺乏前瞻性研究调查皮肤点刺和皮内试验、血清特异性 IgE 和扩展口服挑战在诊断报告有β-内酰胺过敏的儿童中的相对作用。
确定有即刻和非即刻既往反应的β-内酰胺过敏儿童的皮肤试验和血清特异性 IgE 的灵敏度和特异性。
招募了 400 名有父母报告的β-内酰胺过敏史的儿童参加一项开放性前瞻性研究。收集了详细的过敏史。排除了有医学观察和记录的过敏反应史、需要肾上腺素或严重皮肤不良反应的儿童。共有 380 名儿童接受了所有检测方式和直接激发试验。每个孩子至少随访 3 年。
儿童真正的过敏很罕见；有 8.3%的儿童对直接激发挑战或 5 天的扩展口服激发挑战有反应。报告头孢菌素过敏或 1 年内有反应的儿童更有可能对直接激发测试有反应。皮肤测试的灵敏度、特异性和阳性预测值分别为直接挑战结果的 12.5%、98.8%和 20.0%，扩展挑战结果的 4.76%、99.0%和 25.0%，以及两项挑战联合的 6.9%、99.0%和 40.0%。随访调查显示，5.7%的儿童有轻度重复反应，2.7%的儿童尽管成功洗脱标签但仍继续避免罪魁祸首。因再次住院而重新贴标签的儿童比例为 15%，重新贴标签的依据不足。
真正的β-内酰胺过敏很罕见，超过 90%的儿童有效地洗脱标签。皮肤和血清特异性 IgE 检测并不能帮助诊断儿童β-内酰胺抗生素过敏，无论其病史如何。扩展口服挑战在确认过敏和增强父母信心方面非常有价值。
