Original ArticleShort protocol for the study of paediatric patients with suspected betalactam antibiotic hypersensitivity and low risk criteria
Introduction
The suspicion of hypersensitivity (HS) to drugs is a very frequent cause of medical consultation. In Spain, such situations account for about 7.5% of all patients seen in paediatric allergology clinics.1 Betalactam antibiotics (BLAs) are the drugs most often implicated in cases of suspected HS, due to their widespread use in the empirical treatment of infections in childhood. However, evaluation of these patients rarely confirms such suspicion.2, 3, 4 In our prior series of 503 children under 15 years of age seen for suspected HS to BLAs over a period of seven years, tolerance was confirmed in 68% of the cases, while 25% failed to complete the study (generally due to lack of consent or dropout), and only 6% (32) were diagnosed with allergy to BLA.5 This diagnosis proved significantly more probable in patients with a history of repeated or serious reactions, and in those administered BLAs via the parenteral route.
Based only on the clinical history, it is often difficult to establish whether the suspect reaction was of an immediate type or not. Although skin and laboratory tests are of little help in studying non-immediate reactions6 – which seem to be the reactions most commonly seen in children – they are often performed in order to add supposed safety and reliability to the study of the patients. The study protocols developed by different scientific societies require several patient visits and are targeted at adults.7 Only oral provocation allows the establishment of a definitive diagnosis.8
Based on these considerations, our group developed a protocol for the clinical study of children referred to our clinics with suspected HS to BLAs. The main characteristic of the protocol is its simplicity, justified by the very low frequency of HS to BLAs in childhood, and the mild nature of the symptoms involved. The present study describes the results obtained in the first year of application of the protocol, with a view to establishing its clinical applicability, and proposes a study algorithm inspired by the experience gained.
Section snippets
Material and methods
After evaluating our own experience and reviewing the recent literature, a protocol was developed for the study of paediatric patients (under 15 years of age) referred for the evaluation of suspected HS to some BLA. The data compiled on the first visit allowed us to evaluate the plausibility of the suspicion and assign the patients to one of the following two groups:
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Group A, corresponding to risk subjects, defined by the presence of at least one of the following circumstances:
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Typical urticaria
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Results
In the first year of application of the described protocol, we attended 78 children referred due to suspected HS to BLA. There were 37 males and 41 females, with a mean age of 3.4 years at the time of the suspect episode and of 6.7 years at the time of consultation. The implicated drugs are reported in Figure 1. Twenty-two patients were assigned to group A (Table 1) and 56 (72%) to group B. Compilation of the case history in turn showed that five patients had tolerated the suspect BLA at some
Discussion
As in many other aspects of medical and allergological practice, children are not small adults. The study protocols proposed by the main expert groups and warranted by the scientific societies are based on experiences and studies from adult populations.11 Studies in children are fewer, and have not allowed the development of specific protocols for securing a correct diagnosis.
However, paediatric allergology clinics receive an important number of patients requiring evaluation for suspected
Financial support
This study has received no external funding, but has been awarded the second prize for the best oral communication at the XXXIV Congress of the Spanish Society of Pediatric Allergy and Clinical Immunology.
Conflicts of interest
No specific conflict of interest can be detected.
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