Oral Provocation Test Research Articles

Delabelling multiple antibiotic allergy: Practical issues.

With the growing incidence of multi-drug resistant organisms, delabelling incorrect antibiotic allergies has become an integral part of antimicrobial stewardship worldwide. For example, around 90% of penicillin allergy labels are found to be inaccurate following a full allergy work-up, which deprive patients the use of effective first-line penicillin antibiotics and increase the risk of antimicrobial resistance with the use of other extended spectrum non-penicillin antimicrobials. Significant numbers of adult and paediatric patients over time are labelled with multiple penicillin and non-penicillin antibiotic allergies often during inappropriate antimicrobial use, resulting in a label of "multiple antibiotic allergy". In contrast to delabelling penicillin allergy where oral direct provocation tests can be used for low-risk, mild reactions, and sensitivity/specificity/positive and negative predictive values of skin tests have been demonstrated, diagnostic tests for multiple antibiotic allergy often require the use of a combination of in-vivo and in-vitro tests across different antimicrobial classes for evaluation. Shared decision making with patients and informed consent are also needed when prioritising which drugs to delabel first, balancing the risks, benefits of testing vs. interim use of alternative antibiotics. Similar to delabelling penicillin allergy, the cost-effectiveness of delabelling multiple drug allergies is unknown.

Current Causes and Clinical Pattern of Fixed Drug Eruption at a Tertiary Care Hospital

Objective: To identify the current common causative drugs and the clinical pattern of FDE in Pakistani patients presenting to a Tertiary Care Hospital.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Dermatology Combined Military Hospital, Kharian Pakistan, from Nov 2018 to Oct 2021.
 Methodology: Patients of all ages and sexes reporting in dermatology outpatient during the study period with Fixed drug eruption (FDE) were included in the study after taking informed consent. Diagnosis of FDE was based on the finding of welldemarcated erythematous patches or plaques and violaceous pigmentation. In cases where history was not suggestive, the drug was confirmed by an oral provocation test. In addition, the causative drug, site(s) affected, duration, number of skin lesions, history of FDE, and the purpose for using the drug were noted for each patient.
 Results: Sixty-one patients were included in the study. Doxycycline (thirteen patients, 21.3%) was the commonest causative drug, followed by Quinolones and Paracetamol in ten (16.4%) patients each, Cotrimoxazole in eight (13.1%) patients and Nonsteroidal anti-inflammatory drugs (NSAIDs) in seven (11.5%) patients. Multiple lesions were common in patients with a history of FDE. The disease affected single-body sites in 16(26.23%) patients only. The most common site was the genital area in forty-two (71.19%) patients, followed by upper limbs in thirty-one (52.54%) patients and lips in twenty-eight ...............
 Conclusions: Knowing the current causative drugs and carefully seeking a history of FDE may help prevent recurrent FDE.

Can clarithromycin be used without testing in patients with penicillin allergy?

BackgroundPenicillin hypersensitivity is a common cause of suspected and proven drug allergy and drug-induced anaphylaxis in medical records and causes social and economic burdens. ObjectiveSince the rate of clarithromycin hypersensitivity is low in the general population, we aimed to investigate whether clarithromycin can be prescribed to patients with penicillin allergy without a provocation test. MethodsThe medical records of 186 patients referred to our clinic between 2015 and 2021 with a history of penicillin allergy were evaluated retrospectively. Patients having a history of at least two immediate-type hypersensitivity reactions with penicillin antibiotics or having a history of immediate-type hypersensitivity with penicillin and diagnosed by positive penicillin V/G specific IgE and/or penicillin skin tests were included in the study. Penicillin skin tests were performed according to the manufacturer's instructions. Concentrations of serum specific IgE against phenoxymethylpenicillin (penV) and benzylpenicillin (pen G) were determined using The Phadia CAP System FEIA method. An oral drug provocation test with clarithromycin was performed in all patients. ResultsThe data of 64 patients diagnosed with penicillin allergy and who underwent clarithromycin oral provocation test were analyzed. Oral provocation test with clarithromycin was positive in only two of these patients (3%). These two patients had a history of multidrug hypersensitivity, and one of them also had food and venom allergies. ConclusionWe suggest that clarithromycin can be given without an oral provocation test when an alternative antibiotic is required in patients with penicillin allergy and without multidrug hypersensitivity.

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.

Recent Updates in Understanding NSAID Hypersensitivity.

To provide a review of available literature regarding nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with an emphasis on more recent findings. Oral provocation tests with aspirin are important for diagnosis and management in adult and pediatric populations with reported NSAID hypersensitivity. Risk of cross-reactivity to COX-2 inhibitors varies by NSAID hypersensitivity phenotype. COX-2 inhibitors are tolerated in aspirin-exacerbated respiratory disease. Reported NSAID allergy is associated with a higher risk of a substance use disorder. Effective treatment of underlying chronic spontaneous urticaria can allow tolerance of NSAIDs in NSAID-exacerbated cutaneous disease. The pathophysiology, cross-reactivity, and appropriate diagnostic evaluation differ between the 5 distinct NSAID hypersensitivity phenotypes. Further research into the pathophysiology of NSAID hypersensitivity in patients with and without underlying disease is needed.

Treatment protocol with alternative iron drugs in patients with an allergic reaction during iron replacement therapy

In our study, we aimed to show that alternative iron salts containing different additives are safe to use in patients who have type 1 hypersensitivity reactions to iron drugs and need iron replacement therapy. Materials and methods: Between January 2022 and June 2022, patients who had previously developed type 1 hypersensitivity reactions with iron preparations and needed iron replacement were included in the study. The study was designed retrospectively. Skin tests were first performed on patients to demonstrate a type 1 hypersensitivity reaction. If skin tests were negative and there was no history of life-threatening anaphylaxis, oral provocation tests were continued. If the absence of variability in symptoms and perimeter values, the drug allergy test was considered negative. Results: Twenty-two patients were included in the study. Twenty-one of the patients were female and one was male. Iron deficiency anemia was found in nine patients, and low iron stores in thirteen patients without anemia were found. Type 1 hypersensitivity reaction developed with Iron 3 Carboxymaltose in 7 patients, Iron 2 Sulfate in 5 patients, Iron 2 Glycine in 4 patients, Iron 3 Hydroxy Polymaltose in 4 patients, Iron 2 Fumarate in 1 patient and Iron 3 Hydroxide Sucrose in 1 patient. Allergy tests with all alternative iron drugs containing additional additives were negative. Conclusion: If patients with allergic reactions cannot be referred to allergy clinics, we think that oral iron salts with different additives can be used after the first dose is given in the hospital under general anaphylaxis precautions. We show that oral iron salts containing different additives can be safely used.

Cardiovascular Changes during Oral Food Challenge and Drug Provocation Test in Children Detected by Noninvasive Hemodynamic Monitoring

The prompt recognition of allergic reactions during oral food and drug challenge (OFC/DPT) in children is crucial. Non-invasive hemodynamic monitoring may help in early detection of the reactions. We sought to describe cardiovascular changes and test their performance in predicting the reaction during OFC/DPT.

L’induction de tolérance orale à la noix de cajou et/ou à la pistache chez 50 patients : l’expérience rémoise

IntroductionWe present the results of a retrospective study conducted for a pediatric DES dissertation on oral immunotherapy (OIT) with cashew nuts and/or pistachios. ObjectiveTo evaluate the efficacy of OIT (evolution of skin test size, specific IgE (IgEs), and total cumulative dose (TCD) tolerogenic and/or reactogenic at 12 months of OIT) and the adverse effects. Material and MethodCashew and/or pistachio OIT was proposed to 50 patients agedto 18 years with cashew and/or pistachio allergy or sensitization between January 2017 and June 2020.Tolerogenic or reactogenic TCD were determined when oral provocation test (OPT) were performed at 0, 6, and 12 months from the start of OIT. IgE and skin tests were performed before each OPT. ResultsAt 12 months of OIT the mean skin test size (mm) tended to decrease for cashew (from 9.4 to 6.4) and pistachio (from 8.62 to 5.04). Mean IgEs values (AU/mL) tend to decrease for cashew (from 3.61 to 2.02), rAnao3 (from 4.05 to 1.60) and pistachio (from 4.68 to 2.34). Mean DCT tended to increase (from 1042 to 5506mg). Allergic reactions were mild, 44% of patients at 1st OPT, 11% at 2nd OPT and 15% at 3rd OPT had grade 1 reactions according to Ring and Behrendt classification. 36% of patients were mild home adverse events (grade 1). 14% at 1st OPT had grade 2 reactions and 10% had grade 3 reactions. There were no reactions grade 4 or more. ConclusionCashew and/or pistachio OIT is effective, as evidenced by the decrease in skin tests and IgEs, but especially the increase in TCD protecting the child from anaphylactic accident and this without significant adverse effects either in day hospitalization or at home. The use of protocols with tolerogenic rather than reactogenic TCD and close medical and therapeutic education support contribute to these results.

Drug reintroduction testing and beta-lactam hypersensitivity in children: Protocols and results, a 12-year experience.

Introduction: Oral provocation test (OPT) to beta-lactam antibiotics (BL) is a gold standard in allergology investigation. We aimed to demonstrate the contribution of OPT in BL hypersensitivity (HS) indicated as a first step in diagnosis. Methods: We conducted a retrospective study from 2007 to 2019, in a single Tunisian tertiary care academic center. It concerned children with presumed non-severe allergic manifestations to BL, with a reaction that has occurred at least 6months before the OPT. Results: We identified 35 children for inclusion. After the first OPT, a second OPT with a different BL was performed in case of a positive result of the first one. In 12 cases (34.2%), the OPT elicited a reaction. In eight cases the allergy was to penicillin and in two cases to cephalosporins (cefixim). Cross-reactivity was noted in two cases. Conclusion: An OPT to BL indicated in the first instance in non-severe reaction in children will allow a rapid diagnosis in case of suspicion of HS to BL.

Харчова алергія. Сучасний погляд на діагностику та лікування

Abstract. Food allergy is an urgent health care problem. The incidence of food allergies has been increasing since the 1990s. The main factors contributing to the emergence of food allergies are presented: the hygienic hypothesis; sibling effect; the theory of double allergen exposure, etc. The gut microbiome plays a role in the pathogenesis and the course of food allergy. Patients with food allergy have distinct gut microbiomes compared to healthy controls. The development of food allergy is preceded by an imbalance of the intestinal microbial ecosystem. Diet, probiotics, prebiotics, symbiotics, and faecal microbiota transfer are potential microbial therapeutics for the prevention and treatment of food allergy. Diseases and syndromes associated with food allergy are considered. Diseases and syndromes associated with food allergy are considered. The main methods of food allergy diagnosis are provided: skin prick tests, laboratory serum tests, oral provocation test. Changing perceptions about the treatment of food allergies: treating food allergies with different methods of specific immunotherapy instead of avoiding allergenic foods. The FDA has already approved the oral immunotherapy treatment of peanut allergy with Palforzia AR101 allergen. The article lists the main drugs for medical treatment of food allergies, in particular omalizumab. Patients with food allergies should always carry an epinephrine injection device, which is the mainstay of pharmacotherapy for anaphylaxis.

A Literature Review on Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis and its Complications

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are delayed-type hypersensitivity reactions to medications. Early signs of identification and proper management are critical for patients’ survival. The distinct features initially resemble influenza-like conditions, malaise, and fever with gradual pain and lesions in the oral, ocular, and genital areas along with other systemic symptoms. SJS/TEN can be differentiated: SJS by the degree of skin involvement and TEN by the degree of exfoliation. In SJS, skin involvement is < 10%, whereas in TEN, skin involvement is > 30%; overlapping among the two develops with 10–30% skin involvement. For the identification of culprit drugs, oral provocation tests, patch testing, and in vitro assay tests are used. The estimation of mortality rates for SJS/TEN has been performed by using SCORTEN- severity-of-illness score for toxic epidermal necrolysis. Sulfonamides, anti-epileptics, NSAIDs (oxicams), and allopurinol are some of the medications with a high risk of SJS/TEN development. Drug-mediated SJS/TEN is facilitated by genetic involvement particularly HLA antigens along with CYP450 genetic variants. Most frequent clinical features include mucosal involvement of nasopharyngeal, esophageal, and genital regions accompanying blisters and erosions. A multidisciplinary approach is required for the handling and treatment of SJS/TEN. It is mandatory to withdraw the contributing medicine followed by supportive therapy. Clinical management involves the use of corticosteroids, cyclosporine, and immunoglobulins.

Dupilumab increases aspirin tolerance in NSAID-exacerbated respiratory disease.

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) comprises the triad of chronic rhinosinusitis with nasal polyps, asthma and intolerance to NSAIDs. Dupilumab treatment, targeting the interleukin-4 (IL-4) receptor α, significantly reduces polyp burden as well as asthma symptoms. Here we aimed to investigate the effect of dupilumab on aspirin intolerance, burden of disease and nasal cytokine profiles in patients with N-ERD. In this open-label trial, adult patients with confirmed N-ERD were treated with dupilumab for 6 months. Clinical parameters (e.g. total polyp scores, quality of life questionnaires, smell test, spirometry), oral aspirin provocation testing and blood, nasal and urine sampling were monitored at regular intervals for up to 6 months after starting dupilumab therapy. Of the 31 patients included in the study, 30 completed both aspirin provocation tests. After 6 months of treatment with dupilumab, 23% of patients (n=7 of 30) developed complete aspirin tolerance and an additional 33% of patients (n=10 of 30) tolerated higher doses. Polyp burden was significantly reduced (total polyp score: -2.68±1.84, p<0.001), while pulmonary symptoms (asthma control test: +2.34±3.67, p<0.001) and olfactory performance improved (University of Pennsylvania Smell Identification Test: +11.16±9.54, p<0.001) in all patients after therapy. Patients with increased aspirin tolerance showed a significant decrease in urinary leukotriene E4 levels and their improvement in clinical parameters was associated with a reduction of eotaxin-1, C-C motif chemokine ligand 17, IL-5, IL-17A and IL-6. In this study, 57% of N-ERD patients tolerated higher doses of aspirin under dupilumab therapy.

Barriers to paediatric penicillin allergy de-labelling in UK secondary care: a regional survey

BackgroundIncorrect penicillin allergy labels result in the use of inappropriately broad-spectrum antibiotics. De-labelling inaccurate penicillin allergy promotes antimicrobial stewardship and optimises prescribing practices. The objectives were to evaluate paediatric clinicians’...

Diagnostic Value of Oral Provocation Tests in Drug Hypersensitivity Reactions Induced by Nonsteroidal Anti-Inflammatory Drugs and Paracetamol.

Oral drug provocation tests (DPT) are the basic diagnostic tool for the detection of hypersensitivity to non-opioid analgesics and for selecting a safe alternative for a patient. They are of great practical importance due to their common use, but the data on the follow-up of patients after negative DPT are still very scarce. We examined the further fate of 164 such adult patients after negative NSAID or paracetamol tests and analyzed which excipients in the studied drugs they could be exposed to after the diagnostic workup. A structured medical interview was performed 32.9 months (mean) after the provocation tests. Of the 164 patients, 131 (79.9%) retook the tested drug and 12 developed another hypersensitivity reaction, giving the estimated negative predictive value of 90.8%. These reactions were induced by acetylsalicylic acid, paracetamol, meloxicam, and diclofenac, and were clinically similar to the initial ones (most commonly urticaria and angioedema). There are 93 generics of these drugs on the local market, containing a total of 33 excipients for which hypersensitivity reactions have been reported. All available generics contain such excipients. Thirty-one patients (20.1%) did not take the previously tested drug again, most often because it was not needed or because they were afraid of another reaction. DPT with analgesics has a high diagnostic performance. A minority of patients had relapsed after reexposure. One of the underestimated reasons for this may be drug excipients provoking a reaction, so it is advisable to use exactly the same medical product that has been negatively tested. Many patients avoid reexposure to a given drug, despite negative tests, therefore very reliable patient education in connection with DPT is highly needed.

A new classification option for NSAID hypersensitivity: Kalyoncu classification.

The European Network for Drug Allergy (ENDA) proposed a consensus document for hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) in 2011. A subgroup of patients with NSAIDs-exacerbated respiratory disease (NERD) develop urticaria/angioedema type reactions in response to NSAIDs. The Kalyoncu classification might be a novel option to classify patients with NSAID hypersensitivity (NH). In this study, we compare the ENDA and the Kalyoncu classifications. This study enrolled a total of 196 patients. NH reaction types were categorized as asthma, rhinitis, urticaria/angioedema and anaphylaxis. Based on the reaction history and oral provocation test findings, patients were grouped according to ENDA and Kalyoncu classifications. The mean age of the 196 patients was 40.32±13.28 years, and 130 (66.3%) of them were female. Under the ENDA and Kalyoncu classifications, the most common NH subgroups were NERD (32%), and isolated NH (34.2%), the least prevalent NH subgroups were single NSAID-induced delayed reactions (SNIDR) (1.5%), and pseudo Samter's syndrome (11.7%). Our research revealed that the Kalyoncu classification is more descriptive of patients with NERD exhibiting urticaria/angioedema-type reactions. It also provides future risk assessment for development of NERD. For controversial cases, the Kalyoncu classification can be utilized as a new complimentary option alone or in conjunction with ENDA classification.

Successful Diflunisal Desensitization in a Transthyretin Amyloidosis Patient With Ibuprofen Allergy: A Case Report

Background: Amyloid diseases are hereditary and include transthyretin (TTR) amyloidosis where subunit protein mutations may occur in genes for TTR, leading to the deposition of fibrils (low molecular weight subunits (5 to 25 KD of proteins) in extracellular tissues. By reducing the formation of TTR amyloid, diflunisal, a nonsteroidal anti-inflammatory drug, can preserve the quality of life and significantly reduce disease progression. We present a case of a 61-year-old male patient with a history of ibuprofen allergy, diagnosed with TTR amyloidosis, complicated with peripheral neuropathy, cardiac, and liver amyloid. He developed bilateral mild eye swelling from the ibuprofen oral provocation test. With a similar structural backbone of carboxylic acid, he could develop pseudoallergy to diflunisal with an unknown likelihood of developing an allergic reaction.&#x0D; Objectives: This study aims to design successful diflunisal desensitization in a patient with TTR amyloidosis.&#x0D; Methods: The patient underwent a 14-step diflunisal desensitization procedure using 2 tablets of diflunisal 500 mg that was dissolved in 40 mL of sodium bicarbonate 8.4% injection to create serial 10-fold dilutions. Oral desensitization was administered in the escalation of the doses at 30-min intervals, with a starting dose of 0.1 mg until a final dose of 250 mg was reached.&#x0D; Results: The patient tolerated diflunisal desensitization and was continued on diflunisal treatment without any evidence of an allergic reaction.&#x0D; Conclusion: Diflunisal desensitization can be considered in patients with a history of ibuprofen allergy if there are no available alternative treatments. To the best of our knowledge, this is the first article describing a patient with angioedema to ibuprofen who could tolerate oral diflunisal after desensitization.

Prevalence of reported food allergies in Brazilian preschoolers living in a small Brazilian city

IntroductionAlthough the prevalence of allergic diseases, including food allergies, has increased over recent decades, relevant information on this topic is still lacking, particularly in younger children living in small cities.ObjectiveTo investigate the prevalence of reported food allergies in preschoolers in Limoeiro/Pernambuco, Brazil.MethodsThis was a cross-sectional study with preschoolers. Parents/guardians of all preschoolers enrolled at municipal schools between March and June 2019 (total of 619) were invited to complete a screening questionnaire (total of 619). Another 151 questionnaires were applied on the streets of the town. For positive responses, a second, more detailed and validated questionnaire was completed.ResultsA total of 412 questionnaires were returned, of which, 47 presented a positive response to food allergies and only 29 (7.04%) identified a particular food. The most frequently reported food items were shrimp, mollusks, pork, fruit and milk. Of the 29 who identified foods, 22 responded to the detailed questionnaire, resulting in only 4 (0.97%) positive responses. Of these, two were later discarded through clinical examinations and an open oral provocation test, resulting in a final prevalence of 0.48% of confirmed food allergies.ConclusionThe prevalence of reported food allergies was lower than that described in previous studies. The most commonly mentioned foods were shrimp, mollusks and pork, with more reports of multiple food allergies, even in children who had never been previously exposed to these possible allergens, which highlights the relevance of perception in reported food allergy studies.

Tea-induced chronic urticaria: A case report and review of the literature

Sir, Urticaria is an immunologically mediated hypersensitivity reaction developing in both sexes. Although it may occur at any age, young females are more frequently affected [1]. Acute urticaria, shorter than six weeks, is generally self-limited. In contrast, a patient with urticaria lasting more than six weeks is classified as having chronic urticaria. Patients with chronic urticaria may be classified into either chronic inducible urticaria or chronic spontaneous urticaria (CSU). Urticaria may be either a true IgE mediated allergic reaction or a non-IgE mediated pseudo-allergic reaction by releasing prostaglandins and leukotrienes [2]. A routine test usually includes CBC, ESR, and infection screening. Provocation tests for physical urticaria and immunological tests are performed to identify autoimmune urticaria. Skin prick tests and oral provocation tests are employed to differentiate allergic and pseudo-allergic reactions [3]. In contrast to physical urticaria, in which the triggering physical stimuli is usually easy to identify, it is often cumbersome to determine the trigger of chronic spontaneous urticaria. The following case represents an example of such a hidden trigger of CSU.

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: does age matter?

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are reported to be the leading cause of drug hypersensitivity reactions. The aim of this study was to characterize a cohort of patients with NSAID hypersensitivity and establish if there are any differences between two groups of adult patients, under 55 years old and over 55 years old, and identify safe alternative options. Methods: Patients with NSAID hypersensitivity who were referred to a single tertiary Allergy center from January 2019 to December 2021 were included. Clinical information was obtained from a review of medical records. Results: A total of 135 patients with a history of NSAID-induced hypersensitivity reactions were included, 80 patients under 55 years old and 55 patients older than 55. Most of the patients enrolled were female (80.74%) and the mean age was 50.21 years, ranging from 18 to 78 years old. The time interval between the first reaction and the allergy work-up was longer in the older group (average timeframe 6.87 years) than in the younger group (average timeframe 3.77 years). The main culprit was metamizole in both groups. An oral provocation test to paracetamol was performed in most of the patients who tolerated the intake of 1000 mg, except for 2 patients who developed angioedema. Conclusion: Angioedema was the most encountered symptom in our population. Age does not influence the allergy work-up of patients with a history of NSAID-induced hypersensitivity reactions. The drug provocation challenge remains the gold standard for finding a suitable alternative in patients with NSAID-induced hypersensitivity.

ЗНАЧЕНИЕ ОРАЛЬНЫХ ПИЩЕВЫХ ПРОВОКАЦИОННЫХ ПРОБ В ВЕДЕНИИ ДЕТЕЙ С АТОПИЧЕСКИМ ДЕРМАТИТОМ

One of the important tasks in the management of children with atopic dermatitis (AD) is the assessment of tolerance to previously excluded foods. An oral provocative test is considered to be the «gold standard» of confirming/excluding the presence of food allergies (FA), but food provocative trials are a potentially dangerous method of diagnosis. Objective of the study: to evaluate the feasibility of using oral provocative tests when expanding the diet in children with AD and allergy to cow's milk proteins (CMP). Materials and methods of research: a single-center cohort retrospective study was conducted. 154 patients with AD aged from 1 to 17 years had an oral provocation test with cow's milk for assessing the informativity of the concentration of IgE specific to CMP. At the first stage of the study, the incidence of symptoms, the time of onset of reactions, and the frequency of delayed reactions were assessed. The second step was to analyze the diagnostic informativeness of concentration of specific IgE to CMP in order to determine the value of the IgE-specific concentration, in which a provocative test to introduce cow’s milk into the diet would be the safest. To detect sensitization in all patients, the concentrations of specific IgE (ImmunoCAP Fadia test system) in blood serum to CMP were preliminarily determined. The result was considered positive when the values of the concentration of specific IgE&gt;0.35 IU/ml. Results: a positive result of the provocative test was observed in 44 (28.6%) patients, delayed-type reactions – in 24 (54.5%). CMP-Specific IgE was detected in 62 (40.2%) of 154 patients, of which a positive result of provocative tests was observed in 16 (25%) children. In 92 patients, the concentration of CMP-Specific IgE was below 0.35 kU/l, of which a positive provocative test result was observed in 28 (30%). The probability of a positive result at a concentration of specific IgE ≤0.35 kU/l is 25.8%, at a concentration above 1.5 kU/l – 40%, at a concentration above 2.0 kU/l – 61.5%. Conclusion: oral provocation tests are a necessary component in the management of children with AD induced by FA. This technique should be used not only to confirm the diagnosis of FA, but also when introducing products into the diet.