Prospective assessment of diagnostic tests for pediatric penicillin allergy: From clinical history to challenge tests.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ibáñez María Dolores, Rodríguez Del Río Pablo, Lasa Eva Maria, Joral Alejandro, Ruiz-Hornillos Javier, Muñoz Candelaria, Gómez Traseira Carmen, Escudero Carmelo, Olaguibel Rivera Jose María, Garriga-Baraut Teresa, González-de-Olano David, Rosado Ana, Sanchez-García Silvia, Pérez Bustamante Socorro, Padial Vilchez Maria Antonia, Prieto Montaño Patricia, Candón Morillo Rocío, Macías Iglesia Eva, Feliú Vila Angélica, Valbuena Teresa, Lopez-Patiño Ana, Martorell Antonio, Sastre Joaquín, Audícana María Teresa, Penicillin Allergy in Children (APENIN) Task Force. Pediatric Allergy Committee, Spanish Society of Allergy and Clinical Immunology (SEAIC)
Аннотация
OBJECTIVE: To assess the accuracy of tools for diagnosis of penicillin allergy in children.
METHODS: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs).
RESULTS: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007).
CONCLUSION: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children.