Short protocol for the study of paediatric patients with suspected betalactam antibiotic hypersensitivity and low risk criteria

Abstract

Background: Suspected hypersensitivity to betalactam antibiotics in children is a frequent cause of consultation that proves costly in terms of resource utilization--particularly time. Such hypersensitivity is, however, rarely confirmed.

Methods: A short protocol was introduced in which patients at low risk (single episode with mild, non-immediate skin symptoms after the administration of a betalactam antibiotic via the oral route) were subjected to oral provocation (following the obtaining of informed consent) without any other prior evaluations. Patients failing to meet these requirements were studied according to the protocol of the EAACI (specific IgE and skin testing prior to oral provocation).

Results: A total of 78 patients (56 at low risk) were studied. Five patients had tolerated the medication after the episode, while another six patients failed to complete the study. The study with oral provocation was completed in the remaining 67 patients: according to the protocol of the EAACI in 17 patients, and using the short protocol in 50 patients. Only one patient showed a positive provocation test, of a delayed and mild nature.

Conclusions: Direct oral provocation in low risk patients has been shown to be effective and safe in discarding hypersensitivity to betalactam antibiotics in the majority of the patients studied.