Prospective assessment of diagnostic tests for pediatric penicillin allergy, from clinical history to challenge tests✰,✰✰,✰✰✰

Publication date: Available online 25 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): María Dolores Ibáñez, Pablo Rodríguez del Río, Eva Maria Lasa, Alejandro Joral, Javier Ruiz-Hornillos, Candelaria Muñoz, Carmen Gómez Traseira, Carmelo Escudero, Jose María Olaguibel Rivera, Teresa Garriga-Baraut, David González-de-Olano, Ana Rosado, Silvia Sanchez-García, Socorro Pérez Bustamante, Maria Antonia Padial Vilchez, Patricia Prieto Montaño, Rocío Candón Morillo, Eva Macías Iglesia, Angélica Feliú Vila, Teresa Valbuena, Ana Lopez-Patiño, Antonio Martorell, Joaquín Sastre, María Teresa Audícana
BackgroundDiagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use.ObjectiveTo assess the accuracy of tools for diagnosis of penicillin allergy in children.MethodsA prospective multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol consisting of clinical history, skin tests, serum specific IgE, and, regardless of these results, drug provocation tests (DPT).Results732 children (mean 5.5 years; 51.2% males) completed the allergy work-up, including DPT. 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 subjects (4.8%): 6(17%) immediate and 29(83%) non-immediate reactions in the DPT. No severe reactions were recorded. The allergist diagnosis based upon the clinical history was not associated with the final outcome at DPT. In 30 of 33(91%) allergic patients, all skin tests and sIgE were negative. A logistic regression model identified the following to be associated with PNC allergy (p<0.05): a family history of drug allergy (OR=3.03; 95% confidence interval (CI): 1.33-6.89), an IR lasting >3 days vs ≤24 hours (OR=8.96; 95% CI: 2.01-39.86), and IR while receiving corticosteroids (OR=2.68; 95% CI: 1.30-5.54).ConclusionConventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of non-severe penicillin allergy in children.



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