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Non‐immediate‐reading skin tests and prolonged challenges in non‐immediate hypersensitivity to beta‐lactams in children
Author(s) -
Lezmi G.,
Alrowaishdi F.,
BadosAlbiero A.,
Scheinmann P.,
Blic J.,
Ponvert C.
Publication year - 2018
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12826
Subject(s) - medicine , provocation test , allergy , pediatrics , prospective cohort study , surgery , immunology , alternative medicine , pathology
Background A minority of children reporting non‐immediate reactions to beta‐lactams (BLs) are allergic. Allergy workup usually includes late‐reading (48‐72 hours) skin tests (ST) and short (1‐3 days) drug provocation tests (DPT), regardless of the chronology of the index reaction. The sensitivity of hyper‐late‐reading (≥6‐7 days) ST and of prolonged DPT for the diagnosis of non‐immediate hypersensitivity to BLs is yet to be determined. Objectives To establish the diagnostic values of late‐reading ST and hyper‐late‐reading ST and of prolonged DPT in children reporting non‐immediate reactions to BLs. Methods Prospective assessment of children reporting non‐immediate reactions to BLs with late‐ and additional hyper‐late‐reading intradermal (ID) and patch tests, and if negative, with prolonged DPT. Results Five hundred and fifty children reporting reactions to a single or several BLs (674 suspected BLs) were included. Non‐immediate hypersensitivity to BLs was diagnosed in 63 children (11.5%), reporting 66 reactions (9.8%), based on responses in ST (n = 17, 25.8%: 5 to ID, 8 to patch tests, and 4 to both tests), DPT (n = 43, 65.2%), and clinical history (n = 6, 9.1%), including 3/9 children with severe cutaneous adverse reactions. Skin test positivity was observed after the 6‐7th day in 14/17 children, and DPT positivity after a median time of 3 days. No severe reaction was observed after ST or during prolonged DPT. Conclusion Additional hyper‐late‐reading of ST enhanced their positivity. However, their overall sensitivity remained weak, especially in non‐severe cases. Prolonged DPT are safe and may improve the performance of DPT in the diagnosis of non‐immediate hypersensitivity to BLs.