SIAIP position paper: provocation challenge to antibiotics and non-steroidal anti-inflammatory drugs in children

Carlo Caffarelli,Lucia Liotti,Lucia Diaferio,Carla Mastrorilli,Stefania Arasi,Silvia Caimmi,Fabio Cardinale,Paolo Bottau,Pasquale Comberiati,Dora Di Mauro,Davide Caimmi,Francesca Mori,Giuseppe Crisafulli,Francesca Saretta,Gian Luigi Marseglia ,U Pelosi ,Marzia Duse,Fabrizio Franceschini,Simona Barni,Francesco Paravati

doi:10.1186/s13052-018-0589-3

Abstract

Drug hypersensitivity reactions (DHRs) in childhood are mainly caused by betalactam or non-betalactam antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs). Laboratory tests for identifying children who are allergic to drugs have low diagnostic accuracy and predictive value. The gold standard to diagnose DHR is represented by the drug provocation test (DPT), that aims of ascertaining the causative role of an allergen and evaluating the tolerance to the suspected drug. Different protocols through the administration of divided increasing doses have been postulated according to the type of drug and the onset of the reaction (immediate or non immediate reactions). DPT protocols differ in doses and time interval between doses. In this position paper, the Italian Pediatric Society for Allergy and Immunology provides a practical guide for provocation test to antibiotics and NSAIDs in children and adolescents.

Highlights

Data on prevalence and incidence of drug hypersensitivity reactions (DHRs) are limited, especially in the pediatric age and varies around the world [1]
In prospective studies conducted in children and adolescents, the rate of adverse drug reactions was 10.9% in hospitalized children, 1.0% in outpatients, and the hospitalizations rate for adverse drug reactions was of 1.8% [3]
We summarized below the current knowledge on hypersensitivity reactions to specific non-betalactam antibiotics (NBLA) specific studies are scarce

Summary

Introduction

Data on prevalence and incidence of drug hypersensitivity reactions (DHRs) are limited, especially in the pediatric age and varies around the world [1]. In a large study involving both children and adults [31] most of the reactions elicited by DPT were mild, non-immediate and cutaneous (urticaria or rash). In case of immediate reactions to beta-lactams that occurred more than 6 months before a negative DPT, another drug challenge may be performed after 2–3 weeks, to exclude a possible re-sensitization. In mild cutaneous delayed reactions, it is suggested to perform only DPT [2, 48, 49] because of its high negative predictive value [50, 51], without skin testing and serum IgE measurement. A recent study by Chiriac and colleagues [52] have suggested a new protocol for DPT to beta-lactams based on the analysis of 182 positive challenge tests They administered four doses, containing 5-15-30-50% of the single therapeutic dose, with additional steps in case of anaphylaxis. A meta-analysis involving 268 adults with HIV infection and mild or moderate hypersensitivity reactions to cotrimoxazole found that the desensitization protocol was

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