Mild Cutaneous Reactions Research Articles

Antepartum vs postpartum amoxicillin oral challenge in pregnant patients with a reported penicillin allergy: A two-center prospective cohort study.

While 10% of pregnant individuals report a penicillin allergy, there is no established best practice for penicillin allergy delabeling in pregnancy. To better understand options for penicillin delabeling, we aimed to evaluate two penicillin allergy delabeling protocols in pregnancy regarding efficacy, adverse events, and patient satisfaction. From July 2019 to December 2022, we completed a two-center prospective cohort study, where each site recruited pregnant patients over 24 weeks gestational age with a reported penicillin allergy. One center offered antepartum amoxicillin oral challenges, either directly or after negative skin testing (i.e., antepartum oral challenge site). Our other centers completed a two-step approach with antepartum penicillin skin testing only and deferred oral challenges to the postpartum period (i.e., postpartum oral challenge site). Our primary outcome was the rate of penicillin allergy delabeling, defined as tolerating an antibiotic challenge with penicillin or amoxicillin. Univariate analyses were completed using chi-squared, Fisher's exact, and Wilcoxon rank tests. During the study period, 276 pregnant patients were assessed, with 207 in the antepartum oral challenge site and 69 in the postpartum oral challenge site. Among the 204 patients who completed antepartum oral challenges, 201 (98%) passed without reactions. Deferring oral challenges to the postpartum period led to a loss of follow-up for 37/53 (70%) of eligible individuals. Overall, 97% (201/207) of patients at the antepartum oral challenge site were delabeled from their penicillin allergy-compared to 38% (26/69) of patients referred to the postpartum oral challenge site (p < 0.0001). Three antepartum oral challenge reactions were noted, including two mild cutaneous reactions and a case of transient abdominal discomfort. Antepartum amoxicillin oral challenge is a more effective method to delabel pregnant patients from their penicillin allergy. Deferral of oral challenges to the postpartum period introduces a significant barrier for penicillin allergy delabeling.

Non-IgE-mediated drug-induced hypersensitivity reactions in pediatrics.

Despite their prevalence and potential severity, non-IgE-mediated drug-induced hypersensitivity reactions (DHRs) are under-researched and poorly defined, particularly in children. Presentations range from mild cutaneous reactions to severe systemic diseases, with pathophysiological mechanisms and reliable diagnostic markers not well established. The lack of validated tests often leads to permanent drug restrictions, reliance on second-line drugs, and increased costs. Focusing on recent advancements and areas needing further research, this review aims to enhance children's recognition, diagnosis, and management of non-IgE-mediated DHRs. Recent studies have enhanced the understanding of immediate and delayed non-IgE-mediated drug reactions. Key findings include the Mas-related G protein-coupled receptor X2 in mast cells and the identification of HLA alleles linked to severe cutaneous adverse reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Improved diagnostic techniques, including skin testing, show promise in identifying immediate and delayed non-IgE DHRs. Additionally, research highlights the impact of cofactors, drug metabolites, and co-infections on these DHRs and explores potential biomarkers for predicting reaction severity. Non-IgE-mediated DHRs are a significant cause of morbidity and treatment changes in pediatric patients. Recent research underscores their clinical presentations and mechanisms, paving the way for more precise diagnostic and therapeutic strategies to improve patient outcomes.

Retrospective evaluation of hypersensitivity reactions and anaphylaxis in dogs (2003-2014): 86 cases.

To characterize anaphylactic reactions in dogs, including clinical signs, severity, treatments, prognosis, and estimated incidence. To determine whether glucocorticoids influence clinical recovery and survival. Retrospective study between January 1, 2003 and April 28, 2014. University teaching hospital. Eighty-six dogs treated for a type I hypersensitivity reaction. Nineteen dogs fulfilled the criteria for anaphylaxis, and 67 dogs had mild cutaneous reactions. None. The estimated incidence was 0.04% for anaphylaxis and 0.15% for mild hypersensitivity reactions. The female:male ratio (2.3:1) was significantly higher (P=0.032) compared to our source population (ratio of 1:1.158). Vaccines were the most frequent trigger for anaphylaxis (57.9%) and mild hypersensitivity reactions (28.4%). Seventy-four (86%) dogs had cutaneous signs, and 11 (57.9%) dogs with anaphylaxis had no cutaneous signs reported. Forty-two (48.8%) dogs received both an H1 antagonist and a glucocorticoid, 34 (39.5%) dogs received an H1 antagonist only, and 6 (6.9%) dogs received a glucocorticoid only. The majority of the dogs survived, and 1 was euthanized due to complications. Clinical signs associated with nonsurvival included respiratory signs (P=0.006), particularly respiratory distress (P<0.00001) and cyanosis (P<0.00001), and circulatory shock (P=0.005). The analysis of the interaction between etiology, clinical signs, treatment, and outcome did not show any association between pairs of variables. In the current study, anaphylaxis had a relatively good prognosis, and cutaneous signs were not always present. Based on the present data, the use of glucocorticoids to treat mild type I hypersensitivity reactions and anaphylaxis in dogs was not associated with clinical improvement or survival.

The pharmacogenomics of carbamazepine-induced cutaneous adverse drug reaction in the South of Vietnam.

Background: The relationship between HLA-B*15:02 and Severe Cutaneous Adverse Reactions was rigorously examined in Japanese, Han Chinese, Thais, and Caucasians. However, the number of studies about this topic in Vietnamese population is still limited and mostly focuses on the North of Vietnam. Objective: This study aims to clarify the genetic culprit of SCARs in Vietnamese population, particularly in the South of Vietnam, and to validate our result by a meta-analysis about this topic in Vietnamese. Method: A retrospective case-control study with 37 patients treated with carbamazepine monotherapy. Statistical calculation and meta-analysis were performed by R software. Result: HLA-B*15:02 increases the risk of SJS 12.5 times higher in CBZ-treated patients (p-value = 0.017). However, this allele has no impact on MCARs (Mild Cutaneous Adverse Reactions) of CBZ. The number needed to test and the number needed to genotype is two and nine patients respectively. Conclusion: This study recommends more investigations about the cost-effectiveness of this test to accelerate the protection of Southern Vietnamese from SCARs.

Risk Factors of Challenge-Proven Beta-Lactam Allergy in Children with Immediate and Non-Immediate Mild Cutaneous Reactions

Introduction: Beta-lactam (BL) antibiotics are the most often involved drugs in allergic reactions. Mild cutaneous reactions such as maculopapular exanthema or urticaria are the most common presenting complaints of BL allergy in the pediatric population. However, it can be challenging to distinguish BL-induced allergy from reactions due to infections or other reasons. In this study, we aimed to determine the clinical characteristics and potential risk factors of true BL allergy in children with suspected mild cutaneous reactions to BLs. Methods: We evaluated children who were admitted to our pediatric allergy clinic with suspected BL allergy in between January 2015 and March 2020. Patients with a history suggestive of immediate and non-immediate mild cutaneous reactions were included in the study. The oral challenge test (OCT) with the culprit drug was performed on all patients to confirm the diagnosis. Results: Two hundred fourteen (119 male and 95 female) patients with a median age of 4.9 years were evaluated. BL allergy was confirmed in 10.7% (23) of the patients, according to the OCT results. Most of the proven allergic reactions were of the immediate type (73.9%), and urticaria was the most common presenting complaint (60.8%) in proven BL-allergic patients. The negative predictive value of penicillin-G skin testing was 89.7% for immediate-type penicillin allergy and 93.4% for non-immediate reactions. Also, positive predictive value of penicillin-G skin testing was 50% for immediate and 25% for non-immediate reactions. In the multivariate logistic regression analysis, a history of proven drug allergy (Exp (B): 7.76, 95% CI: 1.88–31.97, p = 0.005) was found to be the risk for BL allergy. Conclusion: This study highlighted that OCTs should be performed to confirm the diagnosis in patients suspected of immediate and non-immediate mild cutaneous reactions to BLs and remove the overestimated “BL allergy” label. In these patients, a history of proven drug allergy might be a risk factor for true BL allergy.

Safety of direct oral provocation test to delabel reported mild beta-lactam allergy in infants.

Around 10% of people report a drug allergy and avoid some medications because of fear of allergic reactions. However, only after a proper diagnostic workup can some of these reactions be confirmed as allergic or nonallergic hypersensitivities. Beta-lactams (BLs) are the most common medication suspected of being involved in drug hypersensivity reactions (DHRs) in children. Recently, direct oral provocation tests (DPT) with BLs gained popularity within pediatric populations as a tool for delabeling children with suspected BL allergies. This study aimed to evaluate the safety of direct provocation tests in infants with mild cutaneous non-immediate reactions to BLs. The authors retrospectively analyzed the data of 151 infants between 2015 and 2022, referred for evaluating a suspected allergy to BLs that occurred before age 24 months. The mean age of the children, including 55% male kids, at the suspected reaction was 15.9 months and the mean age at the time of the DPT was 39.6 months. In most cases, antibiotics were prescribed to treat common upper respiratory infections, such as acute otitis (54.3%) and acute tonsillitis (27.2%). Amoxicillin was considered the culprit drug in 62.9% of the cases, and the combination of amoxicillin-clavulanic acid in the case of 33.8% of children. The most frequent associated cutaneous clinical manifestations were maculopapular exanthema in 74.8% and delayed urticaria/angioedema in 25.2%. Of the 151 infants evaluated, parents of 149 infants agreed for a direct DPT, and only three had a positive test (2%). Symptoms resulting from the DPT were mild and easily treatable. A direct DPT without prior tests is a safe and effective procedure to delabel BL allergy, even in infants. The authors wish to emphasize the importance of properly validating BL allergy suspicions by promoting appropriate diagnostic procedures in infants as, in most cases, DHRs can be excluded and there is no need for further therapeutic restrictions.

Comment on “Cutaneous adverse reactions of COVID‐19 vaccines: A systematic review”

We read with interest the article published by Shafie'ei et al.1 regarding a systematic review and meta-analysis of all reported cutaneous side effects of COVID-19 vaccines. Our experience with COVID-19 cutaneous reactions is largely consistent with prior reports of mild, self-limiting cutaneous reactions.2-4 We note reports describing cutaneous vasculitis following COVID-19 vaccination.5 In contrast to the reported mild cutaneous reactions following COVID-19 vaccination, we report the case of a severe prolonged IgA vasculitis following the single dose Janssen COVID-19 vaccine—Ad.26.COV2.S. A 60-year-old Caucasian woman self-presented to the emergency department due to an extensive painful rash affecting her bilateral lower limbs. She described a petechial rash affecting her lower limbs 8 h post the single dose COVID-19 vaccine 11 days prior. Within 10 days, she had developed extensive palpable purpura circumferentially at both lower limbs from the knee distally as well as affecting her thighs and lower abdomen and was referred to dermatology by the emergency physicians (Figure 1A). This was on a background of psoriasis, psoriatic arthritis and hypertension. Her longstanding medications included naproxen, amlodipine, and fexofenadine, and she denied any symptoms of infection. She was apyrexial, and her systems review and examination were unremarkable. Blood tests taken revealed a mildly elevated c-reactive protein of 14 mg/L (normal: <7 mg/L) and erythrocyte sedimentation rate of 26 mm within the first hour (normal: <13 mm) and a normal white blood cell count of 6.41 × 109/L (normal: 3.5–10.5 × 109/L). A chest x-ray and midstream urine showed no evidence of infection. At this time, super-potent topical steroids were prescribed. A punch biopsy taken from her right lower limb demonstrated findings consistent with a leukocytoclastic vasculitis (Figure 2). Direct immunofluorescence demonstrated IgA deposits within vasculature. On follow-up review, tense bullae were seen at her bilateral ankles. Treatment prescribed at this time consisted of tapering oral steroids, oral antibiotics for secondary infection and wound care. The bullae ruptured to leave multiple punched-out and exquisitely painful ulcers (Figure 1B). It was noted that her urinary protein creatinine (UPCR) ratio was uptrending and rose to a value in excess of 100 mg/mmol (normal 0–15 mg/mmol). Complete resolution of the aforementioned lower limb ulceration was noted following 5 months of oral steroid treatment (Figure 1C). Imaging, colonoscopy, and mammography were negative for malignancy. IgA vasculitis represents a small vessel vasculitis brought about by the activation of neutrophils and deposition of IgA at perivascular sites.6 We note a prior case report of postvaccination IgA vasculitis resolving 4 weeks after onset.5 In our case, the complete resolution of the vasculitis and secondary ulceration were noted following 5 months of treatment with oral corticosteroids, which represents the longest reported case. Additionally, our patient had secondary renal involvement with preserved renal function. Her regular medications of naproxen and amlodipine were commenced 5 years prior to this presentation and so were deemed unlikely to be causative. Malignancy and infection were out-ruled. While this presentation may have been coincidental, the relationship between immune complex vasculitis and vaccination has been reported5 and represents the most likely pathophysiological explanation in our patient's case. We feel this case is worth highlighting as it demonstrates a prolonged and severe cutaneous reaction to COVID-19 vaccination. All authors contributed to the editing and execution of this piece. None. The authors report no conflict of interest. The data that support the findings of this study are openly available in Pubmed at https://pubmed.ncbi.nlm.nih.gov/. The patient reported in this article has provided written consent for clinical images to be used in publication.

Association of HLA Alleles with Antiepileptic Drug-Induced Mild Cutaneous Reactions: A Case-Control Study of a Northeast Han Chinese Population.

Human leukocyte antigen (HLA) is associated with drug-induced cutaneous adverse reactions, including antiepileptic drugs (AEDs). HLA gene polymorphism has a regional discrepancy, and it is therefore important to study it in different populations. To investigate the role of HLA in AED-induced mild cutaneous adverse drug reactions (cADRs) in a Northeast Han Chinese population. A case-control study was performed in the First Hospital of Jilin University between August 2016 and March 2017. In total, 26 patients with mild cADRs induced by AEDs and 23 AED-tolerant control patients were included. Sequence-based typing (SBT) was used to detect HLA-A and HLA-B genotypes. Differences in genotype frequencies between groups were assessed using Fisher's exact test. In the mild cADRs group, 22 patients (84.6%) presented with maculopapular exanthema (MPE) and four patients (15.4%) presented with an isolated itch. The median duration between the AED exposure and cADRs was 7.5 days (IQR, 3 - 14 days). We failed to find statistically significant differences in HLA alleles between the cADRs group and the control group when considering all the drugs included in our study together or when considering oxcarbazepine (OXC), carbamazepine (CBZ), and levetiracetam (LEV) alone (P > 0.05). Our findings indicated that there was no correlation between HLA alleles and AED-induced mild cADRs in the Northeast Han Chinese population.

Prior antihistamine agent successfully impaired cutaneous adverse reactions to COVID‐19 vaccine

The coronavirus disease 2019 (COVID‐19) vaccine is positively changing the health crises of this pandemic and is currently essential to overcome the COVID‐19 pandemic. The vaccine shows high efficacy against the infection and impairs the severity of symptoms. However, this vaccination is associated with concerns, such as vaccine‐associated adverse reactions, which are currently highlighted issues for clinicians. We experienced two cases of mild cutaneous adverse reaction following COVID‐19 vaccine administration, which was successfully controlled by prior administration of the antihistamine agent fexofenadine 3 days before COVID‐19 vaccination for 7 days.

New diagnostıc perspectives in the management of pediatrıc beta-lactam allergy.

Since overdiagnosis of beta-lactam (BL) allergy is common in the pediatric population, delabeling is a critical part of antimicrobial stewardship. Undesirable consequences of inaccurate BL allergy labeling can be handled by incorporating traditional delabeling or newer risk-based strategies into antibiotic stewardship programs. Conventional assessment of BL allergy relies upon a stepwise algorithm including a clinical history with skin testing followed by drug provocation tests (DPTs). However, a growing number of studies highlighted the suboptimal diagnostic value of skin testing in children. Recently, there has been a paradigm shift in the practice of BL allergy assessment due to recent challenging data which emphasize the safety and accuracy of direct DPTs in children with a suspicion of non-immediate mild cutaneous reactions such as maculopapular eruption, delayed urticaria, and possibly also for benign immediate reactions such as urticaria/angioedema. Identifying low-risk BL allergy patients, in whom skin tests can be skipped and proceeding directly to DPTs could be safe, has become a hot topic in recent years. New risk stratification and predictive modeling studies that have the potential to better predict BL allergy risk status have recently been introduced into the field of drug allergy, particularly in adults. However, in contrast to adults, risk assessment studies in children are rare, and optimal risk definitions are controversial. In the coming years, promising potential methods to elucidate the predictors of BL allergy in children will require multidimensional approaches that may include predictive analytics, artificial intelligence techniques, and point-of-care clinical decision tools.

A Simple Algorithmic Approach Allows the Safe Use of Cephalosporin in "Penicillin-Allergic" Patients without the Need for Allergy Testing.

Patients who report a penicillin allergy are often given second-line antibiotic prophylaxis during total joint arthroplasty (TJA), with only a minority of patients undergoing additional consultations and allergy testing. In an effort to increase the use of cephalosporin prophylaxis in TJA, the present study aimed to assess the effectiveness of a simple, protocol-driven penicillin allergy screening program without the need for additional work-up. Following implementation of a questionnaire-based screening protocol in May 2019, all patients scheduled for primary TJA were risk-stratified into low or high-risk categories. The low-risk cohort received cefazolin, and the high-risk cohort received non-cefazolin antibiotics. Patients were monitored prospectively, and data on antibiotic usage and adverse outcomes were documented. The protocol group (n = 2,078) was propensity score matched 1:1 with a control group that included patients who underwent TJA in the same institution prior to implementation of the protocol. The primary end point was the efficacy of the protocol in reducing unnecessary use of non-cephalosporin antibiotics for prophylaxis. Secondary outcomes included the rate of surgical site infections and allergic reactions to the administered antibiotic. A total of 357 patients (17.2%) reported a penicillin allergy in the protocol group compared with 310 patients (14.9%) with a recorded allergy in the control group (p = 0.052). The number of patients who received non-cephalosporin antibiotics was significantly lower in the protocol group (5.7% compared with 15.2% in the control group; p < 0.001), whereas there was no difference in the rate of total allergic reactions (0.8% compared with 0.7%, respectively; p = 0.857). Of the 239 low-risk patients (66.9%) in the protocol group, only 3 (1.3%) experienced a mild cutaneous reaction following cefazolin administration. There were no differences in the rates of superficial wound, deep periprosthetic, or Clostridioides difficile infections between the protocol and control groups. A simple screening protocol allowed two-thirds of patients with a self-reported allergy to receive cefazolin without the need for additional consultations or testing. We believe this protocol can be safely implemented to increase the rate of cefazolin usage without a corresponding increase in the number of allergic reactions. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Establishing Amoxicillin Allergy in Children Through Direct Graded Oral Challenge (GOC): Evaluating Risk Factors for Positive Challenges, Safety, and Risk of Cross-Reactivity to Cephalosporines

Data on the diagnostic properties of direct oral challenges without the use of skin tests in children with suspected amoxicillin allergy are sparse. Assess the use of direct oral challenges. A cohort study was conducted between March 2013 and March 2020, in Montreal and Winnipeg. All children referred with reported history of benign reactions (ie, limited to the skin with no mucosal lesions and no vesicles) to amoxicillin were recruited and a 2-step graded oral challenge (GOC) was conducted. Data were collected on demographic characteristics, clinical characteristics, and comorbidities. Eligible children were followed to assess reactions to subsequent use of amoxicillin and to assess the safety of cephalexin use in children with a positive GOC. Among 1914 children recruited, 1811 (94.6%) tolerated the GOC, 42 (2.2%) developed mild immediate reactions, and 61 (3.2%) developed mild nonimmediate reactions. Among 265 participants who had a negative GOC and reused amoxicillin, 226 (85.3%) reported tolerance and 39 (14.7%) had mild cutaneous reactions. Chronic urticaria (adjusted odds ratio [aOR], 1.16; 95% CI, 1.09-1.23) and an index reaction occurring within 5 minutes of exposure (aOR, 1.09; 95% CI, 1.04-1.14) were associated with immediate reactions during the GOC. Symptoms lasting longer than 7 days (aOR, 1.05; 95% CI, 1.02-1.09) and parental drug hypersensitivity (aOR, 1.04; 95% CI, 1.03-1.06) were associated with nonimmediate reactions. Among those reacting to the GOC, 12.5% reacted with mild cutaneous reactions to cephalexin challenge. Direct GOCs are an accurate and safe confirmatory to establish true hypersensitivity among children reporting benign reactions to amoxicillin.

Bendamustine, Gemcitabine and Dexamethasone Chemotherapy Is Effective Salvage and Stem-Cell Mobilization Regimen in Patients with Relapsed or Refractory Hodgkin Lymphoma — Early Results of the Polish Lymphoma Research Group Study

IntroductionBendamustine (B) and Gemcitabine (G) are active agents in relapsed or refractory Hodgkin Lymphoma (rHL) with complete response (CR) rates of around 70%. Potential benefit to combination of B, G and dexamethasone (BGD) as a second-line chemotherapy is unexplored. We report on early results of a run-in phase of a prospective, multicenter study by the Polish Lymphoma Research Group (PLRG) here focused on safety and stem-cell collection efficacy.MethodsPatients with HL were eligible if they had a progressive disease (PD) during initial ABVD treatment or relapsed/progressed after completion of the first-line therapy including irradiation. BGD regimen included bendamustine 90 mg/m2 iv, day 1 and 2, gemcytabine 800 mg/m2 iv, day 1, 4, dexamethasone 20 to 40 mg po daily dose, day 1-4, in 3 week intervals for 4 cycles. Stem-cell collection was performed mostly after 2nd BGD cycle. Treatment was discontinued in case of PD, serious adverse events or patient decision. Response to therapy was evaluated according to RECIL criteria (Younes A et al. Ann Oncol 2017). Patients in CR proceeded to ASCT. Patients with partial response (PR) or disease stabilization (SD) could be referred for ASCT off-study at physician's discretion.Results19 pts were enrolled, 10 male, median age (range) 27 (22-55). 14 pts (73%) were primary refractory, 4 relapsed more than 1 year after the first-line treatment. Eligible patients received 2 (n=8), 3 (n=4), or 4 (n=6) cycles of BGD. 1 patient discontinued BGD after 2nd cycle due to skin reaction and received 1 cycle of ICE before ASCT. PET-CT was performed after 2 (n=16), 3 (n=2), or 4 (n=1) BGD cycles. Response rates were: CR 73% (14/19), PR 11 % (2/19), PD 11% (2/18). PR converted to CR after additional 2 BGD cycles. One additional patient had PD after 3rd BGD . 9 patients received additional BGD cycles awaiting ASCT. At the time of ASCT all 16 patients were in remission with CR rate of 84% by PET-CT. 19 patients were mobilized for stem-cell collection without plerixafor after the second (n=17) or third (n=1) BGD cycle, and 1 patient was mobilized with low-dose cytarabine after the 2nd BGD. A median (range) CD34 cell harvest was 5.2x106/kg (2.0-42.75x106). 11 patients completed and recovered from ASCT. BGD toxicity included pneumonia Grade 3 in 2 patients, mild cutaneous reaction in 2 patients, and 1 case of Grade 4 skin toxicity resulting in change of therapy to ICE after 2 cycles of BGD, nausea grade 3 and fever in patients each were reported. GCSF prophylaxis was administered by local practice.ConclusionsEarly results of BGD regimen as a second-line treatment in patients with mostly primary refractory HL are encouraging with acceptable toxicity, stem-cell collection efficacy, and complete response rate of 84%. A prospective, multicenter study is ongoing. DisclosuresPaszkiewicz-Kozik:Celgene: Other: travel expenses; Servier: Honoraria; Roche: Honoraria, Other: travel expenses; Takeda: Honoraria. Zaucha:sanofi: Honoraria, Other: travel expenses; celgene: Honoraria, Other: travel expenses; Takeda: Honoraria, Other: travel expenses; Roche: Honoraria, Other: travel expenses; servier: Honoraria, Other: travel expenses. Szymanski:sandoz: Other: travel expenses. Targonski:BMS: Other: travel expenses. Drozd-Sokolowska:Celgene: Honoraria, Other: travel expenses; Roche: Honoraria, Other: travel expenses. Wojciechowska-Lampka:celgene: Honoraria, Other: travel expenses. Tajer:Roche: Other: travel expenses. Romejko-Jarosinska:roche: Honoraria, Other: travel expenses; Takeda: Honoraria; Celgene: Honoraria, Other: travel expenses; sandos: Other: travel expenses. Osowiecki:Roche: Honoraria, Other: travel expenses. Walewski:GSK/Novartis: Research Funding; Janssen-Cilag: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Other: travel costs, Research Funding; Servier: Consultancy.

Evaluation of drug patch tests in children.

Background: Patch tests are used to diagnose nonimmediate T-cell-mediated drug hypersensitivity reactions. The aim of this study was to evaluate the results of patch tests performed with suspect drugs in children. Methods: Patients < 18 years of age who had a drug patch test at the pediatric allergy outpatient clinic of our hospital between January 2014 and January 2020 were included in the study. Age, sex, culprit drug(s), reaction characteristics, and patch test results were recorded from the patients' files. Results: A total of 105 drug patch tests were performed on 71 patients during the study period. The patients' median age was 7 years (interquartile range, 4-11 years), and 57.7% (n = 41) were boys. Twenty-three patients (32.3%) had severe cutaneous adverse reaction (Stevens-Johnson syndrome in 11, drug reaction with eosinophilia and systemic symptoms in 9, and acute generalized exanthematous pustulosis in 3 patients), 45 (63.3%) had maculopapular rashes, and 3 (4.2%) had fixed drug eruption. A total of 20 patch test results (28%) were positive: 18 of 44 patch tests (40.9%) with antiepileptic drugs and 2 of 48 patch tests (4.1%) with antibiotics. Positive results were obtained in 23% of the patch tests (6/26) in 20 patients with severe cutaneous adverse reactions and in 17.7% of the patch tests (14/79) in 51 patients with mild cutaneous reactions. No adverse reactions occurred during or after the patch tests. Conclusion: In our study, patch test positivity was more common with antiepileptic drugs and in patients with severe cutaneous drug reaction.

Should Bacillus Calmette–Guérin (BCG) vaccine be used in the prophylaxis of COVID-19?

At present, there is insufficient evidence to support the use of BCG vaccine as prophylaxis for COVID-19. &#x0D; &#x0D; Bacillus Calmette Guerin (BCG) vaccine is an attenuated microorganism derived from bovine tubercle bacillus and&#x0D; &#x0D; is being given to prevent severe tuberculosis.&#x0D; &#x0D; BCG vaccination may enhance production of antibodies and pro-inflammatory cytokines such as interleukin&#x0D; &#x0D; (IL)-1β and tumor necrosis factor (TNF). BCG may lead to increased CD4 and CD8 T-cell activity on subsequent&#x0D; viral infection.&#x0D; &#x0D; Ecological studies on the effect of BCG vaccination policy on COVID-19 outcomes have conflicting results and&#x0D; &#x0D; are prone to bias from confounders.&#x0D; &#x0D; There is insufficient evidence on the efficacy and safety of BCG vaccine for COVID-19 prophylaxis.&#x0D; Thirteen clinical trials are ongoing among high-risk groups (healthcare workers, elderly, police officers) to evaluate&#x0D; &#x0D; the efficacy and safety of BCG vaccine in preventing COVID-19 and its severe symptoms.&#x0D; &#x0D; WHO does not recommend the use of BCG vaccine as prophylaxis against COVID-19.&#x0D; Adverse events of BCG vaccine range from mild local cutaneous reactions to systemic adverse events such as&#x0D; &#x0D; abscess, lymphadenopathy and osteomyelitis.

M102 EXERTIONAL HYPOXIA FOLLOWING INITIATION OF PEANUT ORAL IMMUNOTHERAPY

Peanut oral immunotherapy (OIT) is associated with adverse effects ranging from mild cutaneous reactions to anaphylaxis. However, data on potential long-term effects of OIT on lung function is limited. We report a case of exertional hypoxia during peanut OIT, with partial improvement after discontinuation.

Direct Oral Provocation Test Is Safe and Effective in Diagnosing Beta-Lactam Allergy in Low-Risk Children With Mild Cutaneous Reactions

Direct Oral Provocation Test Is Safe and Effective in Diagnosing Beta-Lactam Allergy in Low-Risk Children With Mild Cutaneous Reactions

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.

Chlorhexidine Allergy: Current Challenges and Future Prospects.

Chlorhexidine is a synthetic bisbiguanide antiseptic and was introduced in healthcare use in 1954. Allergy to chlorhexidine has been increasingly reported particularly in the perioperative and medical procedural settings. The hypersensitivity reactions range from mild cutaneous reactions to anaphylaxis or death. There are many products and medical devices containing chlorhexidine that sometimes lack standardized labeling. With the various routes of chlorhexidine exposure, accidental or recurrent reactions in chlorhexidine-allergic patients have been reported. Therefore, we aim to review the most recent evidence in clinical manifestations, diagnostic methods, management, and preventive measures with a focus on the unique features of chlorhexidine allergy.

The negative predictive value of 5-day drug provocation test in nonimmediate beta-lactam allergy in children

BackgroundExtending the drug provocation test (DPT) period is recommended for patients with suspected nonimmediate beta-lactam antibiotic (BLA) allergy and negative DPT. No consensus has been reached regarding the duration of prolonged provocation. ObjectiveWe aimed to determine the negative predictive value (NPV) of the 5-day extended DPT. MethodsParents of patients with suspected nonimmediate mild cutaneous reactions with BLAs who had been subjected to 5-day DPT with culprit drugs were questioned by telephone interview about reexposure to the tested drug. Patients with reported reaction during reexposure were reevaluated. Skin tests and serum-specific immunoglobulin E (IgE) analysis were not performed before first DPT. ResultsA total of 355 patients had negative results in 5-day DPT. The median age at DPT was 4.2 years, and 52.9% were male. The families of 255 patients (72%) could be contacted. Of these 255 patients, 179 (70%) had used the same drug, and reactions were reported for 6 (3.4%) of those patients, who were subsequently reevaluated. Five of the 6 patients had DPT with amoxicillin-clavulanate and 1 with cefixime. When detailed history was taken, 2 of the 5 patients with amoxicillin-clavulanate reaction were found to have used the drug unintentionally after their reaction to reexposure and did not have any symptoms. One of the patients underwent allergy workup and tested negative, and the other 2 refused the test. The patient with reported cefixime reaction underwent repeated allergy workup and tested negative. Therefore, the NPV of 5-day prolonged DPT was 98.9%. ConclusionThe 5-day prolonged DPT has high NPV and seems appropriate in duration for children with suspected nonimmediate-BLA allergy.