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Title

Oral challenge without skin tests in children with non-severe beta-lactam hypersensitivity: Time to change the paradigm?
Authors
Moral, Luis
Caubet, Jean-Christoph Roger J-P
Published in Pediatric Allergy and Immunology. 2017, vol. 28, no. 8, p. 724-727
Abstract Suspected allergy to penicillins and cephalosporins is very common in childhood. After a proper evaluation, allergy will be confirmed only in a small portion of them. Intradermal tests are usually part of the allergy workup, but they are painful for children and time-consuming, and their role has been debated. A systematic review found only two studies reporting a positive predictive value of skin tests in children of 36% and 33%, respectively, leading to a high rate of inaccurate diagnosis. Moreover, considering that skin tests are negative in more than 90%-95% of cases, an oral provocation test (OPT) is finally needed to confirm tolerance in most of these children. Positive OPT are rare, and even where children demonstrate reproducible signs on challenge, they rarely constitute immediate or serious symptoms. Therefore, OPT to the index antibiotic without skin tests are increasingly being considered an accepted procedure for children with a suspected mild non-immediate reaction related to a beta-lactam antibiotic. Furthermore, a recent research has taken the same approach including children with suspected mild immediate reactions, with similar safety and positive results. In light of recent evidence highlighted, it is now the time for large and multicentric studies to confirm that OPT with the index antibiotic, without skin tests, are safe and convenient for children with a history of a mild reaction with a beta-lactam antibiotic before it can be recommended in pediatric allergy guidelines.
Keywords Administration — Oral — Anti-Bacterial Agents/administration & dosage/adverse effects/immunology — Child — Drug Hypersensitivity/diagnosis — Humans — Immunologic Tests/methods — Sensitivity and Specificity — Severity of Illness Index — Skin Tests — Beta-Lactams/administration & dosage/adverse effects/immunology
Identifiers
PMID: 28892222
Full text
Article (Published version) (196 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Structures
Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique
Research group Pathogenèse et traitement des allergies alimentaires (191)
Citation
(ISO format) 		MORAL, Luis, CAUBET, Jean-Christoph Roger J-P. Oral challenge without skin tests in children with non-severe beta-lactam hypersensitivity: Time to change the paradigm?. In: Pediatric Allergy and Immunology, 2017, vol. 28, n° 8, p. 724-727. doi: 10.1111/pai.12800 https://archive-ouverte.unige.ch/unige:107589

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Deposited on : 2018-09-11

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