Abstract
BackgroundA high number of children are referred to pediatric departments with a suspected allergic reaction to antibiotics. The prevalence of true allergy is considered to be significantly lower than shown from clinical history and symptoms alone. This study investigated the historical use of direct oral challenges at three specialist pediatric departments in Denmark.MethodsIn this retrospective medical record review study, 141 children (69 boys and 72 girls) with a clinical history of suspected penicillin class allergy were investigated. A standardized questionnaire for drug allergy was completed in the beginning of the investigation, which also included a skin prick test (SPT), measurement of IgE to different types of penicillin, and a drug challenge (DC).ResultsOnly four (2.8%) of the patients referred for further investigation in our study had a positive DC. We found no correlation between a positive DC, positive SPT or elevated specific IgE. None of the patients with a positive DC reacted with a rash alone prior to investigation.ConclusionsAllergy to penicillin in children is rare and probably overestimated. In children reacting to penicillin with a rash alone, our study indicated that the rash was probably not related to allergy and treatment should thus be continued.
Highlights
A high number of children are referred to pediatric departments with a suspected allergic reaction to antibiotics
This study investigates the historical use of direct oral challenges at three specialist pediatric departments in Denmark
The American Academy of Allergy, Asthma and Immunology (AAAI) and European Network for Drug Allergy (ENDA)/ European Academy of Allergy and Clinical Immunology (EAACI) have recommend that investigation of suspected IgE-mediated penicillin allergy includes skin testing followed by an oral challenge with a therapeutic dose in skin test-negative individuals [7]
Summary
A high number of children are referred to pediatric departments with a suspected allergic reaction to antibiotics. This study investigates the historical use of direct oral challenges at three specialist pediatric departments in Denmark. The prevalence of true allergy is considered to be Penicillin is among the most commonly used antibiotics in children and often suspected to lead to allergic reactions in children [6]. These mistaken suspicions and Krusenstjerna-Hafstrøm and Rubak BMC Pediatrics (2020) 20:523 often not validated diagnosis of allergy to penicillin increase the risk of doctors prescribing broad-spectrum antibiotics, which could potentially lead to a higher risk of antibiotic resistance. This study investigated potential predictive symptoms and findings and discussed the diagnostics process in allergy to penicillin among children
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