Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.

BACKGROUND: Drug provocation tests (DPTs) are considered the gold standard for diagnosing beta-lactam allergy. However, positive results tend to be mild and difficult to interpret. This study aimed to describe pediatric patients with a presumedly positive or inconclusive DPT, assess the decision to...

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Detalhes bibliográficos
Autores: Moral L, Latorre S, Toral T, Marco N, Canals F, Forniés MJ, González MC, García-Avilés B
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Recursos:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:isabial.fundanetsuite.com:p9245
Acesso em linha:https://isabial.portalinvestigacion.com/publicaciones9245
Access Level:acceso abierto
Palavra-chave:Beta-lactam antibiotics
children
diagnostic accuracy
drug provocation test
false positive reactions
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spelling Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.Moral LLatorre SToral TMarco NCanals FForniés MJGonzález MCGarcía-Avilés BBeta-lactam antibioticschildrendiagnostic accuracydrug provocation testfalse positive reactionsBACKGROUND: Drug provocation tests (DPTs) are considered the gold standard for diagnosing beta-lactam allergy. However, positive results tend to be mild and difficult to interpret. This study aimed to describe pediatric patients with a presumedly positive or inconclusive DPT, assess the decision to repeat the DPT, and describe its outcome. METHODS: Retrospective review of all presumedly positive or inconclusive DPTs performed in six pediatric allergy clinics from 2017 to 2019. We describe the interpretation of results, focusing on the decision to repeat the DPT and its outcome. RESULTS: Of 439 children challenged with a beta-lactam, 26 (5.9%) with a presumedly positive or inconclusive result were included in this study. Most were girls (n = 16, 61.5%), and the median age was 5 years (range 1-13). The initial DPT used amoxicillin (n = 13, 50.0%), amoxicillin-clavulanic acid (n = 12, 46.2%), or cefadroxil (n = 1, 3.8%). Reactions were early (n = 11, 42.3 %), delayed (n = 14, 53.8 %), or not registered (n = 1, 3.8 %), but mild in all cases. A second confirmatory DPT was proposed in 19 patients (73.1%) and performed in 17 patients (65.4%). Nine DPTs were performed from 1 day to 4 months after the first DPT, and the remaining eight took place 6 months to 2 years later. Fifteen children tolerated the drug in the second DPT: 88.2% of those reevaluated and 57.5% of the whole study group. CONCLUSION: The positive predictive value of DPT may be lower than expected. Given the mildness of observed reactions, a second confirmatory DPT is warranted within a few weeks or months.CODON PUBLICATIONS2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://isabial.portalinvestigacion.com/publicaciones9245ALLERGOLOGIA ET IMMUNOPATHOLOGIAISSN: 03010546ISSNe: 15781267reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicanteinstname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)Inglésinfo:eu-repo/semantics/openAccessoai:isabial.fundanetsuite.com:p92452026-06-12T10:20:37Z
dc.title.none.fl_str_mv Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
title Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
spellingShingle Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
Moral L
Beta-lactam antibiotics
children
diagnostic accuracy
drug provocation test
false positive reactions
title_short Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
title_full Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
title_fullStr Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
title_full_unstemmed Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
title_sort Positive drug provocation with beta-lactam antibiotics in children: A single test may not be enough.
dc.creator.none.fl_str_mv Moral L
Latorre S
Toral T
Marco N
Canals F
Forniés MJ
González MC
García-Avilés B
author Moral L
author_facet Moral L
Latorre S
Toral T
Marco N
Canals F
Forniés MJ
González MC
García-Avilés B
author_role author
author2 Latorre S
Toral T
Marco N
Canals F
Forniés MJ
González MC
García-Avilés B
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Beta-lactam antibiotics
children
diagnostic accuracy
drug provocation test
false positive reactions
topic Beta-lactam antibiotics
children
diagnostic accuracy
drug provocation test
false positive reactions
description BACKGROUND: Drug provocation tests (DPTs) are considered the gold standard for diagnosing beta-lactam allergy. However, positive results tend to be mild and difficult to interpret. This study aimed to describe pediatric patients with a presumedly positive or inconclusive DPT, assess the decision to repeat the DPT, and describe its outcome. METHODS: Retrospective review of all presumedly positive or inconclusive DPTs performed in six pediatric allergy clinics from 2017 to 2019. We describe the interpretation of results, focusing on the decision to repeat the DPT and its outcome. RESULTS: Of 439 children challenged with a beta-lactam, 26 (5.9%) with a presumedly positive or inconclusive result were included in this study. Most were girls (n = 16, 61.5%), and the median age was 5 years (range 1-13). The initial DPT used amoxicillin (n = 13, 50.0%), amoxicillin-clavulanic acid (n = 12, 46.2%), or cefadroxil (n = 1, 3.8%). Reactions were early (n = 11, 42.3 %), delayed (n = 14, 53.8 %), or not registered (n = 1, 3.8 %), but mild in all cases. A second confirmatory DPT was proposed in 19 patients (73.1%) and performed in 17 patients (65.4%). Nine DPTs were performed from 1 day to 4 months after the first DPT, and the remaining eight took place 6 months to 2 years later. Fifteen children tolerated the drug in the second DPT: 88.2% of those reevaluated and 57.5% of the whole study group. CONCLUSION: The positive predictive value of DPT may be lower than expected. Given the mildness of observed reactions, a second confirmatory DPT is warranted within a few weeks or months.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://isabial.portalinvestigacion.com/publicaciones9245
url https://isabial.portalinvestigacion.com/publicaciones9245
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv CODON PUBLICATIONS
publisher.none.fl_str_mv CODON PUBLICATIONS
dc.source.none.fl_str_mv ALLERGOLOGIA ET IMMUNOPATHOLOGIA
ISSN: 03010546
ISSNe: 15781267
reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
instname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
instname_str Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
reponame_str r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
collection r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.198674

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