Background

Allergy to beta-lactam (βL) antibiotics is highly reported in children, but rarely confirmed. Risk factors for a positive diagnostic work-up are scarce.

The primary aim was to characterize the cases of children with confirmed βL allergy, investigating potential risk factors. Secondary aims were to assess the prevalence of allergy to βL in this population and to confirm the safety of less extensive diagnostic protocols for milder reactions.

Methods

We reviewed the clinical data from all children evaluated in our Department for suspected βL allergy, over a six-year period.

Results

Two hundred and twenty children (53% females) with a mean age of 6.5 ± 4.2 years were evaluated. Cutaneous manifestations were the most frequently reported (96.9%), mainly maculopapular exanthema (MPE). The reactions were non-immediate in 59.5% of the cases.

Only 23 children (10.5%) were diagnosed with allergy to βL. The likelihood of βL allergy was significantly higher in children with a family history of drug allergy (p < 0.001) and in those with a smaller time period between the reaction and the study (p = 0.046). The probability of not confirming βL allergy is greater in children reporting less severe reactions (p < 0.001) and MPE (p < 0.001).

We found the less extensive diagnostic protocol in milder reactions safe, since only 4.2% of the children presented a positive provocation test (similar reaction as the index reaction).

Conclusion

This study highlights family history of drug allergy as a risk factor for a positive diagnostic work-up. Larger series are required, particularly genetic studies to accurately determine future risk for βL allergy in children.

中文翻译：

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儿童对β-内酰胺类抗生素的过敏：阳性诊断检查的危险因素。

背景

儿童对β-内酰胺（βL）抗生素过敏的报道很高，但很少得到证实。进行阳性诊断检查的风险因素很少。

主要目的是鉴定已证实βL过敏的儿童病例，调查潜在的危险因素。次要目的是评估该人群中对βL过敏的患病率，并确认较轻度反应的较广泛诊断方案的安全性。

方法

我们对六年来在我们部门评估的所有可疑βL过敏儿童的临床资料进行了回顾。

结果

对220名平均年龄为6.5±4.2岁的儿童（53％的女性）进行了评估。皮肤表现是最常报告的（96.9％），主要是斑丘疹性皮炎（MPE）。在59.5％的情况下，反应不是立即发生的。

仅23名儿童（10.5％）被诊断出对βL过敏。有药物过敏家族史的儿童（p  <0.001）和反应与研究之间的时间间隔较短的儿童（p  = 0.046），βL过敏的可能性明显更高。报告不太严重的反应（p  <0.001）和MPE（p  <0.001）的儿童中，不确定βL过敏的可能性更大。

我们发现较轻的反应方案在较轻的反应中是安全的，因为只有4.2％的儿童表现出积极的激发试验（类似于指数反应的反应）。

结论

这项研究突出了药物过敏的家族史，将其作为阳性诊断检查的危险因素。需要更大的系列，尤其是基因研究，才能准确确定儿童βL过敏的未来风险。