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Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number
Author(s) -
Diaferio Lucia,
Chiriac Anca Mirela,
Leoni Maria Chiara,
Castagnoli Riccardo,
Caimmi Silvia,
Miniello Vito Leonardo,
Demoly Pascal,
Caimmi Davide
Publication year - 2019
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.13041
Subject(s) - medicine , provocation test , prospective cohort study , drug allergy , allergy , retrospective cohort study , drug , pediatrics , dermatology , immunology , pathology , pharmacology , alternative medicine
Background There is no perfect agreement on how to perform an allergy workup in suspected beta‐lactam (BL)–allergic children, since skin test (ST)–induced pain is often a limitation. The aim of the study was to assess the possibility of reducing the number of ST in children when performing a complete allergy workup for BL hypersensitivity reactions. Methods A retrospective analysis of all patients referring to the Allergy Unit of the University Hospital of Montpellier (France) with positive responses in immediateand non–immediate‐reading ST to a BL over a 16‐year period was performed, to determine the positive predictive value (PPV) of ST. All pediatric patients with a suspected BL hypersensitivity were skin‐tested with the suspected drug only, during the following 54 months. Results A total of 319 patients reporting 328 BL reactions were included in the retrospective study. The PPV of ST for the reported drug was of 99.4%. Based on the results, the number of patients to include in the prospective study was estimated to be 101. In the prospective study, 229 children were included. We diagnosed a BL hypersensitivity in 12 children (5.2%): Diagnosis was reached in 6 (50.0%) through ST (delayed reading for all) and in 6 through drug provocation test (DPT). Conclusion ST with BL should therefore be performed as a screening test, before DPT, and testing only the suspected drug may be sufficient when dealing with children.