Allergy to beta-lactam antibiotics in children: Risk factors for a positive diagnostic work-up

Autores da FMUP

• Laura Virginia Pereira Teixeira Ribeiro

  Autor

Participantes de fora da FMUP

• de Castro, ED
• Carolino, F
• Carneiro-Leao, L
• Barbosa, J
• Cernadas, JR

Unidades de investigação

• Ciências da Saúde Pública e Forenses, e Educação Médica

Abstract

Background: Allergy to beta-lactam (beta L) 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 beta L allergy, investigating potential risk factors. Secondary aims were to assess the prevalence of allergy to beta L 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 beta L 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 beta L. The likelihood of beta L 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 beta L 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 beta L allergy in children. (C) 2020 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Drug allergy; Beta-lactam antibiotics; Children; Allergy diagnostic work-up; Risk factors