Allergy to betalactam antibiotics in children: a prospective follow-up study in retreated children after negative responses in skin and challenge tests
Allergy to betalactam antibiotics in children: a prospective follow-up study in retreated children after negative responses in skin and challenge tests
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DOI：
10.1111/j.1398-9995.2006.01246.x
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发表时间：
2007-01-01
期刊：
影响因子：
12.4
通讯作者：
Scheinmann, P.
中科院分区：
文献类型：
--
作者：
Ponvert, C.;Weilenmann, C.;Scheinmann, P.
背景：通过皮肤和激发试验排除疑似β内酰胺过敏（HS）的患者中，高达 10% 的患者在使用相同或非常相似的β内酰胺进行后续治疗时报告疑似过敏反应。有人建议，这些反应可能是由过敏检查时进行的挑战引起的重新过敏引起的。然而，大多数患者没有接受第二次过敏学检查，以确定反应是否由β内酰胺HS引起。 目的：我们的目的是确定被诊断为对β内酰胺不过敏的儿童是否能够耐受最初怀疑的和/或其他β内酰胺的后续治疗，以及如果发生反应，该反应是否由β内酰胺HS引起。方法：我们向先前诊断的256名儿童的父母发送了一份有关其孩子的临床病史的调查问卷对β内酰胺类不过敏。对在随后使用相同和/或其他β内酰胺治疗期间报告疑似过敏反应的儿童进行了第二次过敏学检查。使用可疑（或非常相似）的β内酰胺和来自相同类别和其他类别的其他β内酰胺的可溶形式进行皮肤测试。在 15-20 分钟（立即）、6-8 小时（半晚）和 48-72 小时（晚）时评估皮肤测试反应。在医院（立即反应和加速反应）或在家（延迟反应）对皮试阴性的儿童进行口服激发（OC）。结果：从 141 名儿童（55.3%）中获得了反应。其中四十八名 (34%) 的儿童未接受过β内酰胺治疗，之前已排除了他们的过敏诊断。再次接受治疗的 93 名儿童中，有 7 名（7.5%）报告疑似过敏反应。对其中 6 名儿童进行了皮肤测试和 OC，其中 5 名儿童的结果为阴性。在一名先前被诊断为对阿莫西林与克拉维酸相关的非过敏的儿童中，我们诊断出对克拉维酸的迟发型 HS 和对头孢克洛的血清病样疾病。因此，皮肤和激发试验阴性的儿童中由β内酰胺HS引起的反应频率非常低，如果我们认为拒绝第二次过敏学检查的儿童确实对β内酰胺过敏，则不会超过2.1% (2/93)。结论：我们对大量儿童的结果表明，在先前已排除β内酰胺过敏诊断的儿童中，推测由β内酰胺HS引起的反应很少见。此外，他们认为，正如最初的反应所示，后续治疗期间的大多数反应都是由使用β内酰胺治疗的传染病造成的，而不是β内酰胺HS的结果。最后，他们认为口服避孕药重新过敏的风险非常低，并且不支持对诊断为对β内酰胺类药物不过敏的儿童应重复进行皮肤测试的观点。
Background: Up to 10% of the patients in whom suspected betalactam hypersensitivity (HS) has been excluded by skin and challenge tests report suspected allergic reactions during subsequent treatments with the same or very similar betalactams. It has been suggested that the reactions may result from a resensitization induced by the challenge performed at the time of the allergological work-up. However, most patients did not undergo a second allergological work-up, to determine if the reactions resulted from betalactam HS or not.Objectives: We aimed to determine if children diagnosed nonallergic to betalactams have tolerated subsequent treatments with the initially suspected and/or other betalactams, and, in case of a reaction, if the reaction resulted from betalactam HS.Methods: We sent a questionnaire concerning the clinical history of their children to the parents of 256 children previously diagnosed nonallergic to betalactams. A second allergological work-up was performed in the children reporting suspected allergic reactions during subsequent treatments with the same and/or other betalactams. Skin tests were performed with the soluble form of the suspected (or very similar) betalactams and other betalactams from the same and other classes. Skin test responses were assessed at 15-20 min (immediate), 6-8 h (semi-late) and 48-72 h (late). Oral challenge (OC) was performed in children with negative skin tests, either at the hospital (immediate and accelerated reactions), or at home (delayed reactions).Results: A response was obtained from 141 children (55.3%). Forty-eight (34%) of those children had not been treated with the betalactams for whom a diagnosis of allergy had been ruled out previously. Seven (7.5%) of the 93 children who had been treated again reported suspected allergic reactions. Skin tests and OC were performed in six of those children, and gave negative results in five children. In one child previously diagnosed nonallergic to amoxicillin associated with clavulanic acid, we diagnosed a delayed HS to clavulanic acid and a serum sickness-like disease to cefaclor. Thus, the frequency of reactions resulting from betalactam HS in children with negative skin and challenge tests is very low, and does not exceed 2.1% (2/93) if we consider that the child which refused a second allergological work-up is really allergic to betalactams.Conclusion: Our results in a very large number of children show that reactions presumed to result from betalactam HS are rare in children in whom the diagnosis of betalactam allergy has been ruled out previously. Moreover, they suggest that, as shown for the initial reactions, most of the reactions during subsequent treatments are rather a consequence of the infectious diseases for whom betalactams have been prescribed than a result of betalactam HS. Finally, they suggest that the risk of resensitization by OC is very low, and do not support the notion that skin testing should be repeated in children diagnosed nonallergic to betalactams.