Hypersensitivity In Children Research Articles

Drugs and Vaccines Hypersensitivity in Children with Mastocytosis.

Mastocytosis, a heterogeneous mastcell disease, include three different entities: cutaneous mastocytosis, systemic mastocytosis (SM) and mast-cell sarcoma. Tryptase levels can differentiate cutaneous mastocytosis from SM. In mastocytosis, quick onset drug hypersensitivity reactions (DHRs) that are facilitated by mastcell mediators, are investigated in adults. Due to the limited number of children with mastcell disease and increased serum tryptase levels, the role of drugs in this age group is less studied. In this review, we critically assessed relevant papers related with immediate DHRs in children with mastocytosis and discuss practical issues of the management. In childhood mastocytosis, anaphylaxis is frequently idiopathic, and elevated level of basal tryptase, and high burden of disease may increase the risk. Among drugs, antibiotics, NSAIDs and opioids can potentially induce anaphylaxis, anyway avoidance should be recommended only in case of previous reactions. Moreover, vaccinations are not contraindicated in patients with mastocytosis. The risk of severe systemic reactions after drugs intake seems to be extremely low and in general lower in children than in adults. Anyway, studies on this topic especially focusing on children, are missing to state final recommendations.

Hydroxyapatite as Remineralization Agent for Children's Dental Care

Children are prone to develop dental caries. This is supported by epidemiological data confirming early childhood caries (ECC) as a highly prevalent disease affecting more than every second child worldwide. ECC is known to result from an imbalance between re- and demineralization where demineralization dominates due to frequent acid production by cariogenic bacteria present in oral biofilms. The application of oral care formulations containing remineralizing agents helps to prevent dental caries. As young children are sensitive and usually swallow (intended or unintended) a majority of toothpaste or other oral care products during daily dental care, all ingredients, especially the actives, should be non-toxic. Biomimetic hydroxyapatite [HAP; Ca5(PO4)3(OH)] is known to have favorable remineralizing properties combined with an excellent biocompatibility, i.e., it is safe if accidently swallowed. Several clinical trials as well as in situ and in vitro studies have shown that HAP remineralizes enamel and dentin. Remineralization occurs due to deposition of HAP particles on tooth surfaces forming mineral-mineral bridges with enamel crystals, but also indirectly through calcium and phosphate ions release as well as HAP's buffering properties in acidic environments (i.e., in plaque). HAP induces a homogenous remineralization throughout the subsurface enamel lesions. This review summarizes the current evidence showing HAP as an effective remineralizing agent in oral care products for children. Additional studies showing also further beneficial effects of HAP such as the reduction of biofilm formation and the relief of hypersensitivity in children with molar incisor hypomineralization (MIH). It can be concluded that HAP is an effective and safe remineralizing agent for child dental care.

Association between food additives and prevalence of allergic reactions in children: a systematic review.

Food additives contain synthetic and natural chemical compounds and are one of the causes of food allergies. In this regard, it is necessary to recognize the food additives that are of special interest for children. In this survey, the relation between food additives and allergic reactions and attention-deficit hyperactivity disorders in children was studied. The research studies with keywords "allergic reactions", "hypersensitivity", "food additives" and "children" were searched in PubMed, Scopus, Science Direct, Web of Science, and SID databases, from 1984 to 2020. Three hundred twenty-seven studies were obtained and only seven articles were finally selected according to exclusion and inclusion criteria. In the final review, seven articles were selected to investigate the relationship between food additives and hypersensitivity reactions. Some clinical factors such as urticaria, eczema, rhinitis andgastrointestinal symptoms and the prevalence of laboratory evidence in atopic children are due to increased exposure to food additives including artificial colors and sweeteners, preservatives, and monosodium glutamate. Clinical signs and laboratory evidence prove a significant association between some food additives and allergenic adverse reactions. It was also found that food additives such as artificial colors and sweeteners, preservatives, and monosodium glutamate are responsible for most cases of hypersensitivity in children, and the prevalence of hypersensitivity to food additives was estimated to be about 1.2% based on data extracted from studies.

The controversy of drug hypersensitivity in patients with cystic fibrosis and review of the literature.

Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there are conflicting data about true prevalence of drug hypersensitivity in children with CF. The suspicious drug hypersensitivity reactions (DHRs) of children with CF were enquired by the European Network for Drug Allergy (ENDA) questionnaire, and skin tests and/or drug provocation tests were performed according to the established guidelines. Two hundred and nineteen children (48.9% boys; median [IQR] age, 8.4years [4.8-12.4years]) with cystic fibrosis were included in the study, among which 22 patients with 24suspected DHRs were evaluated. Most of the suspected DHRs were of non-immediate (n=16, 66.6%) type, and the offending drugs were amoxicillin-clavulanic acid (n=7), macrolides (n=4), trimethoprim-sulfamethoxazole (TMP/SMX) (n=2), piperacillin-tazobactam (n=1), pancrelipase (n=1), and ursodeoxycholic acid (n=1). Eight (33.3%) of the DHRs were classified as immediate (ceftriaxone [n=2], ceftazidime [n=2], meropenem [n=1], AmBisome [n=2], and vancomycin [n=1]). The main clinical presentations were maculopapular eruption (41.6%) and urticaria (37.5%), accompanied by angioedema (8.3%), flushing (12.5%), and vomiting (8.3%). Nine skin tests (with beta-lactam protocol in 6 patients) and 24 DPTs were performed, and none of the skin tests revealed a positive result; however, 2 DPTs with TMP/SMX were positive. Actual drug hypersensitivity was demonstrated in 2 of 219 patients (0.9%) with non-beta-lactam antibiotics. These results conflict with previous researches that showed higher drug hypersensitivity rates but are consistent with some recent studies. Allergological diagnostic workup is mandatory in patients with cystic fibrosis in case of a suspicious DHR.

Food Hypersensitivity in Children Aged 0–3 Years of the Lviv Region in Ukraine: A Cross-Sectional Study

Aim: To determine the prevalence and to estimate factors associated with food hypersensitivity in young children of the Lviv region in Ukraine.Methods: A prospective cross-sectional survey study was conducted between 2016 and 2017 in the Lviv region of Ukraine. A specially designed questionnaire about food hypersensitivity of young children developed and validated by M. J. Flokstra-de Blok was used after translation into the Ukrainian language. The questionnaire included 34 questions, grouped into general and detailed information. Parents of children aged 0–3 years were asked to complete the questionnaire at pre-schools and medical institutions.Results: Among 4,500 distributed questionnaires, 3,214 (71%) were completed and processed. Parents reported that 25% of their young children had food hypersensitivity. According to the survey the most common agents involved in food hypersensitivity in young children were cow's milk (34%), egg (28%), and wheat (24%). Hypersensitivity to milk occurred in 50% of children in the age group of 1–2 years. Regional differences associated with food hypersensitivity were also found. Namely, in the Carpathians, there was more hypersensitivity to fish (27%) and honey (22%) than in other regions, while hypersensitivity to soy was detected mostly in Lviv City residents (8.5%). Unknown causes of food hypersensitivity were highly reported (34%) in the Carpathians.Conclusion: Prevalence and some distinctiveness of food hypersensitivity revealed in four geographic and climate zones as well as in Lviv City have a considerable practical use for formulation of recommendations for children with food hypersensitivity.

HLA-DRB1*16:02 is associated with PEG-asparaginase hypersensitivity.

Aim: To evaluate the associations between human leukocyte antigen (HLA)-DRB1 variants and the rs6021191 variant in nuclear factor of activated T cells 2 (NFATC2) with PEG-asparaginase hypersensitivity in children with acute lymphoblastic leukemia (ALL) treated according to the Chinese Children Leukemia Group (CCLG) ALL 2018 protocol. Methods:HLA-DRB1 genotyping was performed using a PCR sequence-based typing (SBT) method. NFATC2 rs6021191 was genotyped applying TaqMan Genotyping Assay. Results: T-ALL and higher risk groups were at higher risk for PEG-asparaginase hypersensitivity. No association was found between NFATC2 rs6021191 and PEG-asparaginase hypersensitivity. HLA-DRB1*16:02 variant was associated with PEG-asparaginase allergy both in univariate and multivariate logistic regression analysis. Conclusion: Our results confirm that variations in HLA-DRB1 might influence the development of asparaginase hypersensitivity.

Frequency of detection of allergic reactions to food in children with atopic dermatitis and pathology of the gastrointestinal tract

Background. In recent years, there has been a worldwide tendency to steady increase in the incidence of adverse reactions caused by food. Therefore, at the present stage, the investigation of the prevalence of the main causative factors of the development of food hypersensitivity is still a challenging task for researchers. The purpose was to study the range of food products, which are the most likely allergy-causing for children of the Poltava region, who had a history of unwanted allergic reactions to food. Materials and methods. The study involved 242 children aged from 6 to 15 years, who had a history about adverse reactions caused by food. The basic group included 128 patients with inflammatory diseases of the upper gastrointestinal tract; the comparison group involved 114 children with atopic dermatitis. The detection of the frequency of allergic reactions to food was investigated by using a questionnaire, allergic anamnesis and findings obtained by skin prick tests with food, epidermal, household and pollen allergens. Results. The study has demonstrated that the factors significantly increasing risks of skin and gastrointestinal allergies in the examined children are as following: maternal hereditary burden of allergic diseases; non-compliance in pregnancy, when mothers of examined children neglected to stick to the hypoallergenic diet; early mixed and bottle feeding and improper introducing of solid food. The findings obtained by questionnaire and skin allergic tests demonstrated a higher level of food sensitization in the children of the basic group. It has been also found out that the development of adverse reactions, regardless of skin or gastrointestinal manifestations, is the most often observed when taking cow’s milk, eggs and fish. Conclusions. Thus, the conducted studies have contributed in finding out main risk factors for the development of food hypersensitivity in children and in identifying the most etiologically significant food products that can provoke the development of allergic and gastroenterological diseases.

Clarithromycin hypersensitivity in children: Is there a link with β-lactam hypersensitivity?

Clarithromycin hypersensitivity is reported as the most common cause of non-β-lactam antibiotic allergy in children. Clarithromycin is frequently prescribed in cases of suspected β-lactam hypersensitivity. Oral provocation tests stand as the gold standard to confirm drug hypersensitivity as diagnostic value of skin tests is variable. We analyzed the frequency of true clarithromycin hypersensitivity ratio and its relationship with β-lactam allergy among children with suspected clarithromycin hypersensitivity and evaluated the diagnostic value of skin tests. The study included 160 children referred with suspected clarithromycin hypersensitivity. Clinical history and allergy workups including skin tests or/and oral provocation tests were retrieved from medical records. Oral provocation test confirmed clarithromycin hypersensitivity rate was 5.6% (n=9/160). Skin tests with clarithromycin showed positivity in 32.6% (n=29/89) of the tested patients. The sensitivity of clarithromycin skin tests was negligible, and specificity was 73.9% (95% confidence interval [CI], 64.7-81.8). Eighty-eight of the patients (55%) reported that they had previously tolerated a β-lactam antibiotic. β-lactam hypersensitivity was suspected in 40% (n=64/160) of the patients (simultaneous [n=10], sequential [n=19], distant form [n=35]) in relation with clarithromycin usage. β-lactam hypersensitivity (95% CI, 2.1-70.6, p=.005) and sequential usage of clarithromycin after the development of a rash with amoxicillin-clavulanic acid (95% CI, 2.0-96.4, p=.007) were found as risk factors for confirmed clarithromycin hypersensitivity. The frequency of confirmed clarithromycin hypersensitivity was found low among suspected patients. Oral provocation test is crucial for definite diagnosis. Confirmed β-lactam allergy may be attributed as a risk factor for clarithromycin hypersensitivity, particularly clarithromycin treatment after a developing rash with amoxicillin-clavulanic acid in sequential usage.

Safety of direct oral provocation testing using the Amoxicillin-2-step-challenge in children with history of non-immediate reactions to amoxicillin

BackgroundPrevious studies have shown that direct oral provocation tests, without prior skin testing, in children having delayed onset, benign rashes to beta-lactam antibiotic is safe and effective. Although, this test is useful in confirming drug hypersensitivity reactions, there is no standard protocol recommendation of drug provocation tests. This study aimed to evaluate the safety of the direct oral provocation test, using the Amoxicillin-2-step-challenge without prior skin testing, in children with history of non-immediate reactions to amoxicillin. MethodsThe Amoxicillin-2-step-challenge protocol was performed in children with history of non-immediate reactions to amoxicillin. This protocol is composed of 2 doses of amoxicillin, with a 30-min interval; continued for a total of 5 days. All of the patients had not undergone skin testing before the oral provocation test. ResultsThis study included 54 children, having a median age of 6.6 years, with 70.4% being male. Amoxicillin and amoxicillin-clavulanic acid were reported as the culprit drug in 75.9% and 24.1%, respectively. The index reactions were maculopapular (MP) rash in 79.6% and delayed urticarial rash/angioedema in 20.4%. Five patients (9.3%) had a reaction during the provocation test, all of these patients had delayed urticaria and were treated with oral antihistamine. However, 1 patient developed a fever alongside an MP rash. Laboratory investigation for this patient showed increased atypical lymphocytes and liver enzymes elevation. ConclusionsDirect oral provocation tests, using the Amoxicillin-2-step-challenge, without prior skin testing, revealed good, immediate safety for the diagnosis of amoxicillin hypersensitivity in children with history of non-immediate reactions to amoxicillin.

Exanthematous reactions to drugs in children.

The true exanthematous reactions to drugs in children are rare and overdiagnosed. Drugs may cause exanthema either due to inducing an immune response or because of their interaction with viruses, if drugs are taken in the course of a viral infection. Also, viral infections are very often in children and they can provoke an exanthema which is difficult to differentiate from exanthematous reactions to drugs. Consequently, the majority of children are incorrectly labeled as 'allergic'. The correct diagnosis of exanthematous drug reactions in children is still an important and hot topic. Most information about the approach and management of drug hypersensitivity in children is applied from available guidelines and consensus statement for adults. Recently, a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous exanthema while receiving a drug, is proposed. It is important to consider the detailed clinical history of appearing and developing exanthematous drug reaction, as well as physical examination which includes the description and the distribution of exanthema and at the end making the appropriate diagnosis. Thus, it could reduce overdiagnosis and promote appropriate procedures, that will prevent the overlabeling of drug hypersensitivity in children.

Association of HLA genotypes with Beta-lactam antibiotic hypersensitivity in children.

Beta-lactam (BL) antibiotics hypersensitivity is common in children. Clinical manifestation of BL hypersensitivity varies from mild to severe cutaneous adverse drug reactions (SCARs). To determine the association of HLA genotype and BL hypersensitivity and the prevalence of true drug allergy in patients with history of BL hypersensitivity. A case-control study was performed in 117 children with aged 1-18 years. Children with history of non-SCARs BL hypersensitivity were evaluated for true drug hypersensitivity including skin test and drug provocation test. Tolerant control patients were children who could tolerate BL for at least 7 days without hypersensitivity reaction. HLA genotype (HLA-A, HLA-B, HLA-C and HLA-DRB1) were performed in 24 cases and 93 tolerant controls using PCR-SSO (polymerase chain reaction - sequence specific oligonucleotide probes). There were association of HLA-C*04:06 (OR = 13.14, 95%CI: 1.3-137.71; p = 0.027), and HLA-C*08:01 (OR = 4.83, 95%CI: 1.93-16.70; p = 0.016) with BL hypersensitivity. HLA-B*48:01 was strongly associated with immediate reaction from BL hypersensitivity (OR = 37.4, 95%CI: 1.69-824.59; p = 0.016) while HLA-C*04:06, HLA-C*08:01 and HLA-DRB1*04:06 were associated with delayed reaction (p < 0.05). Among 71 cases who were newly evaluated for BL hypersensitivity, only 7 cases (9.8%) had true BL hypersensitivity. Less than 10% of children with suspected of BL hypersensitivity have true hypersensitivity. There might be a role of HLA-B, HLA-C and HLA-DRB1 genotype in predicting BL hypersensitivity in Thai children.

Beta-lactam hypersensitivity in children: Frequency and risk factors.

To determine the frequency of an authentic β-lactam (BL) hypersensitivity (HS) amongst a large number of children and to identify clinical risk factors that predict this hypersensitivity. All children with suspected BL allergy were evaluated by skin tests (ST) with the suspected BL. A 1-day oral provocation test (OPT) was performed in children with negative ST. We defined an authentic BL-HS case if the child exhibited a positive ST or a positive OPT. Risk factors associated with BL-HS were assessed using a univariate analysis. Covariates showing a P-value <.2 were included in the multivariate logistic regression analysis to determine independent predictors. A total of 354 patients reporting 368 suspected BL reactions were included. The diagnosis of BL-HS was established in 24 children (6.7%). All these children had a positive ST. OPT was performed in 30 patients and was negative in all of them. In 110 children with a negative ST, BL was tolerated. In the risk factors analysis, 164 children were included. Older age (>5years) at the reaction (odds ratio=1.11; 95% confidence interval, 1.01-1.22; P=.02) and BL administered (odds ratio=7.7; 95% confidence interval, 2.76-21.8; P<.001) were significantly associated with authentic BL-HS. BL-HS should be evaluated with an appropriate allergy work-up before strict prohibition is made. In addition, age of patient and BL involved can be used as predictive factors of developing BL-HS in this population.

Drug hypersensitivity in children: a retrospective analysis of 101 pharmacovigilance reports.

Our objective was to describe and discuss management of recent cases of drug hypersensitivity in children reported in a pharmacovigilance center. Two pediatric allergy units conducted a collaborative retrospective analysis of 101 adverse drug reactions reported to a regional pharmacovigilance center between January 2016 and July 2019. Time lapse between hypersensitivity reaction onset and allergy consultation varied from 1month to 12years. Sixty-two patients (61.4%) presented with immediate reactions, 11 (10.9%) with non-immediate reactions, and 28 (27.7%) had reactions impossible to classify through medical interview. Overall, 92 children (91%) were explored for simultaneously administered drugs. All 113 prick tests were negative, and 2 were uncertain. Among 108 intradermal tests, 2 were positive to penicillin and to an iodinated contrast medium, 105 were negative, and 1 was uncertain. Overall, 129 drug provocation tests were proposed. Nine provocation tests among 80 were positive (11.25%): 6 to penicillin, 1 to sulfonamide antibiotics, and 2 to non-steroidal anti-inflammatory drugs; the remaining 71 were negative. No severe reaction was observed during these tests. Finally, drug allergy was only retained in 11 reported cases (10.9%).Conclusion: These pharmacovigilance reports show the difficulty in defining drug allergy in children only by anamnesis, and that explorations, particularly provocation tests, should take place at a reasonable time lapse after drug hypersensitivity reaction onset. What is Known: • True drug allergy is rarely observed in children. • Absence of full workup leads to falsely labeling children as "allergic." What is New: • Short time lapse between hypersensitivity onset and consultation improves classification of pediatric allergy. • Timely allergy consultations are essential, and tests are useful to confirm or exclude pediatric allergy.

Association of food hypersensitivity in children with the risk of autism spectrum disorder: a meta-analysis.

This meta-analysis was performed to clarify the association between food hypersensitivity in children and autism spectrum disorder (ASD) in detail. Relevant studies published in 8 databases before March 2020 were retrieved and screened according to established inclusion criteria. The odds ratio (OR) with the 95% confidence interval (CI) was pooled to estimate the effect. Subgroup analyses were performed in terms of publication year, study design, location, sample size, definition of food hypersensitivity, definition of ASD, and study quality score. Furthermore, we stratified studies by participant sex and age to perform a more detailed analysis. This meta-analysis included 12 published articles with 434,809 subjects. A significant association was observed between food hypersensitivity and the risk of ASD (OR = 2.792, 95% CI: 2.081-3.746). The risk of ASD among girls and subjects younger than 12 with food hypersensitivity may be greater than that among boys and those older than 12. The results of sensitivity analysis and publication bias analysis show that the association is relatively stable.Conclusion: Our results showed a positive association between food hypersensitivity and autism spectrum disorder, and girls and subjects younger than 12 may be more sensitive to this association. The role of food hypersensitivity in the onset of ASD deserves more attention. What is Known: • Food hypersensitivity is a term used to describe food allergies and food intolerance. • ASD is a group of neurodevelopmental disorders that are characterized by deficits in social interaction, repetitive or stereotypic behavior, and verbal communication disorder. • The prevalence rates of ASD and food hypersensitivity in the developed world are increasing. What is New: • In this work, we reviewed and analyzed the available data and studies and found a positive association between food hypersensitivity and ASD. • Girls and children younger than 12 may be more sensitive to have ASD than boys and children older than 12.

Behind the scene: Paracetamol hypersensitivity in children

Paracetamol, a non-steroidal anti-inflammatory drug, is commonly being used for fever and pain relief worldwide. The aim of this study was to evaluate children with a suspected history of paracetamol hypersensitivity. Sixty patients who were referred to our clinic in between January 2015 and December 2018 with a suspected history of paracetamol hypersensitivity were included. Reactions were classified according to the European Network for Drug Allergy (ENDA)/Global Allergy and Asthma European Network classification and European Academy of Allergy and Clinical Immunology (EAACI)/ENDA Position Paper. Diagnoses were confirmed by skin tests and oral challenge tests (OCTs). In those with verified paracetamol hypersensitivity, an OCT with a strong COX-1 inhibitor was performed to classify the type of the reaction to refer as either selective or cross-intolerance hypersensitivity. A subsequent OCT with a selective COX-2 inhibitor was performed in those cross-intolerant patients to find out a safe alternative drug. Sixty OCTs with paracetamol were performed to patients with a median age of 8.5 years, and hypersensitivity to paracetamol was verified in 8 patients. Four children were classified as selective responders, and 3 were classified as cross-intolerant after OCT with a COX-1 inhibitor. Overall, skin test positivity for paracetamol was detected in only one patient, in whom OCT with paracetamol was negative. In all 3 cross-intolerant patients, a safe alternative non-steroidal anti-inflammatory drug was identified after an OCT with a selective COX-2 inhibitor. OCT stands as the gold-standard procedure in verifying the diagnosis of patients with paracetamol-induced drug hypersensitivity, as well as, in defining the type of reactions and finding out safe alternative drugs.

Features of immune regulation and specific sensitization in children of the Northern Siberia

This paper highlights the features of immune regulation and specific hypersensitivity in children residing in the Northern Siberia being exposed to the extreme climatic and exogenous chemical risk factors. An immunological diagnostic examination of 255 children permanently residing in the region of exogenous hapten exposure was conducted. The control group consisted of 130 children residing on the territory not being exposed to exogenous chemical factors. Level of serum class G, A, M immunoglobulins was assessed by using a Mancini radial immunodiffusion reaction. Amount of total serum IgE, neuron-specific enolase, and VEGF was measured by using the ELISA. Changes in level of IgG specific to phenol and copper as well as IgE specific to nickel and benz(a)pyrene were measured by using enzyme-linked allergosorbent test. Peripheral blood lymphocyte subsets were analyzed by using membrane-bound immunofluorescence with a panel of labeled specific monoclonal antibodies. High-quality statistical data analysis was performed by using Microsoft® Office Excel 2003 software as well as Statistica 6.0 application software package (StatSoft, USA). Statistical significance was determined by using Student’s t-test. Relation between signs was estimated by using correlation and regression analysis as well as Fisher’s test. Immunological study demonstrated that immunogram parameters were significantly changed in the observation group by containing increased percentage of CD16+ effector cells absolute and relative CD19+ cell count (p ≤ 0.05), relative and absolute count of CD25+ lymphocytes (p ≤ 0.05) as well as CD95+T cells as compared to the reference values and control group (p ≤ 0.05). Moreover, level of neuron-specific enolase and VEGF (vascular endothelial growth factor) was increased compared to control group (p ≤ 0.05). It points that regulatory mediators potentially mapped to the glia and vascular intima in children from the observation group were extremely activated. The level of both total (total IgE) and specific sensitization was significantly increased by assessing immunoglobulin G specific to phenol as well as immunoglobulin E specific to nickel and benz(a)pyrene (p 0.05). Parameters of programmed cell death were significantly altered that was paralleled with simultaneous activation of general and specific sensitization highlighting features of the immunological status in children examined distinguished by excessive stress of immune regulatory arms in case of combined exposure to climate-geographic as well as exogenous chemical risk factors.

Drug Provocation Tests for Assessing Antibiotic Hypersensitivity: Is Shorter Also Better?

Suspected antibiotic hypersensitivity in children is a frequent reason for consultation. Skin test performance and drug provocation test (DPT) duration are controversial issues. The objective of this study was to assess the effectiveness of diagnostic tests used in the study of antibiotic hypersensitivity and to estimate an optimal duration for DPT. Sixty-two children with a suspected hypersensitivity reaction to antibiotics were studied. Skin tests were performed on all patients. In the case of negative results, DPTs were performed for a duration similar to the time elapsed from the start of treatment until the onset of the reaction. The frequency of antibiotic hypersensitivity in the study population was 8.1% (5 of 62). Only 1 patient showed positive skin tests. The other allergic patients were diagnosed by DPT, which reproduced the reaction within the first 6 hours in all but one of them. Shortening DPT duration may decrease the sensitivity of the test for the diagnosis of non-IgE-mediated hypersensitivity; however, it should be considered as an opportunity to reduce the resulting microbial resistances.

Delabelling Antibiotic Hypersensitivity in Children Is Critical for Future Treatments

Antibiotics are most commonly prescribed drugs in children; among them, beta-lactams are the most frequently used antibiotics. Antibiotic allergy mislabelling is a considerable public health problem which is associated with adverse health and economic outcomes. In this review, the actual antibiotic allergy prevalence, the reasons for overdiagnosis, and the consequences of mislabelling are summarized. The physicians should consider the use of drug provocation tests without prior skin testing in the cases of non-immediate mild cutaneous reactions due to antibiotics as proposed by Pediatric Drug Allergy Task Force of European Academy of Allergy and Clinical Immunology. Mild cutaneous eruptions are quite common in children during viral infections which create a diagnostic challenge. This approach may decrease the time and effort during testing, increase the utility of diagnostic evaluation, and thereby contribute to lessen the ratio of mislabelling as drug hypersensitive. Antibiotic allergy is often overestimated and not accurately diagnosed during childhood. Delabelling antibiotic hypersensitivity is crucial for appropriate management of children because of serious health consequences and economic burden. Alternative antibiotics have broader spectrum leading to development of resistant bacterial infections, have more adverse effects and higher costs, and are usually second line that might be less effective option. A detailed assessment of child with a history of antibiotic hypersensitivity reaction benefits the child, the community, and the healthcare system.

Soy Skin Prick Test in Patients with Physician-Diagnosed Atopic Disorders

Abstract Background Soy protein is an important component of soybeans and is one the 8 most significant food allergens. Yet, the prevalence of soy allergy in the pediatric population is not well defined. Objectives To evaluate the incidence of IgE mediated soy protein sensitization among children with clinical manifestation of atopic disorders by the use of skin prick test (SPT) for soy protein. Methods Two hundred patients with atopic manifestations attending the Pediatric Allergy and Immunology Clinic at the Pediatric Department of Ain shams University, were recruited between January 2017 till January 2018. They were subjected to SPT to soy protein, measurement of total serum IgE and eosinophilic count in the peripheral blood. Results Of the 200 patients, 108 (54%) were males and 92 (46%) were females with a male to female ratio of 1.17:1. Their ages ranged between 2 years and 15 years (mean±SD; 6.0±33.3 years). Seven patients (3.5%) had positive skin prick test to soy protein. The mean value for the absolute eosinophilic count was 0.4x109/L. The median for the total serum IgE level was 50 IU/L. According to age, the highest percentage of soy protein sensitivity was elicited among patients less than 3 years (57.14%), followed by those between 3 to 6 years (28.5%) and those between 6 and 15 years (14.28%). A positive family history of atopy was recorded in 122 (61%) of all cases. In terms of gender, incidence of soya sensitivity was higher among males than females but with no statistical difference. Although the most common allergic manifestations of all studied patients were respiratory (83%), and atopic dermatitis (22.5%), yet positive SPT to soy proteins was elicited in 43% in allergic rhinitis cases, in 29% of asthma patients, in 14% of patients with combined asthma and allergic rhinitis, and 14.3% of patients having eczema. Conclusion Soy protein sensitization is not uncommon in children especially in those with atopic manifestations. Large scale studies are needed to evaluate the actual incidence of soy protein hypersensitivity in children.

Development and validation of the parent-reported Drug Hypersensitivity Quality of Life Questionnaire.

Background. Drug hypersensitivity in children impacts the quality of life of the patients and their caregivers. Measurements of the quality of life in children are different from adults, because children cannot answer the questions. This research aimed to develop and validate the Parent-reported Drug Hypersensitivity Quality of Life Questionnaire (P-DrHy-Q). Methods. The 21-item scale was initially generated by researchers. Then, 3 experts were asked for their opinion about the scale. After adjusting the contents and language, the scale was answered by 97 caregivers. A factor analysis was carried out to select the items for the final scale, and Cronbach's alpha assessed the internal consistency. Finally, we examined the test-retest reliability in another group of 10 caregivers. Results. The 21-item scale was grouped into 6 factors. However, some factors were inappropriate. Therefore, the number of factors was reduced using a statistical analysis. The final 12-item scale included two factors: mental health and social activity. The scale had good internal consistency (Cronbach's á = 0.897) and the test-retest associations were good (R = 0.9439; p minor 0.001). Conclusions. The P-DrHy-Q is the first scale for assessment to consider the interaction of biopsychosocial factors on drug allergy that includes the carer-child dyad. It shows good internal consistency and reliability. Its application might be relevant for future research, and provide clinicians and researchers with a solid tool to define which type of psychosocial support is required to provide more comprehensive care in drug hypersensitivity.