β-lactam allergy in children

Abstract

Objective: beta-lactam antibiotic allergy is the most common drug allergy in children. Most of the patients with suspected reactions to beta-lactam antibiotics can actually tolerate these drugs. The aim of this study is to evaluate clinical and laboratory characteristics of children with beta-lactam allergy and to determine cross-reactivity between penicillin and cephalosporins. Methods: The diagnosis of beta-lactam allergy was made based on the results of skin tests and/or drug provocation tests (DPT). Penicillin allergy skin tests were performed with DAP penicillin (R) (Diater laboratories, Madrid, Spain), penicillin G, and ampicillin/amoxicillin preparations. Skin and provocation tests were performed with the culprit cephalosporin in addition to the penicillin skin and/or provocation tests to evaluate cephalosporin allergy. Results: We found that 87.7% (71/81) of patients with beta-lactam allergy were able to tolerate the culprit drug. Among ten patients with confirmed diagnosis, two had cross-reactivity (penicillin and cephalosporin) and 8 had a various beta-lactam (aminopenicillin n=6, ceftriaxone n=2) allergies. We identified older age and early-type clinical reactions as risk factors for a confirmed beta-lactam allergy. Conclusion: Skin tests and DPT appear to be useful procedures in the diagnosis, and determination of an alternative safe antibiotic in patients with beta-lactam allergy. Most of the patients tolerated the drugs. A minority of the patients with confirmed allergy should avoid all beta-lactam antibiotics due to the probability of cross-reactivity.