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首页> 外文期刊>Clinical and Translational Allergy >Is an extensive allergy diagnosis workup needed in all cases of suspected hypersensitivity to beta-lactams in children?
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Is an extensive allergy diagnosis workup needed in all cases of suspected hypersensitivity to beta-lactams in children?

机译：在所有怀疑对儿童β-内酰胺类超敏反应的病例中，都需要进行广泛的过敏诊断检查吗？

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IntroductionBeta-lactams (BL) are one of the most prescribed antibiotics(AB) class. They are frequently implicated in hypersensitivityreactions (HSR), with common skininvolvement. However, infectious conditions might alsoinduce cutaneous lesions, especially in children, and theyconstitute an important differential diagnosis to BL HSR.AimsTo characterize suspected BL HSR and analyse theprevalence of allergic reactions in our study population.MethodsWe retrospectively reviewed the clinical data from allchildren (<18 years-old) referred to our AllergologyDepartment for suspected BL HSR between 2011 and2013.ResultsEighty children (56.2% females) with a mean age of6.7 yrs (SD=4.035) where evaluated for 83 suspected BLHSR. The mean time elapsed between the reactionand the clinical assessment was of 3.1 yrs (SD=3.36).The most frequently implicated drugs were amoxicillin/clavulanate (54.2%) and amoxicillin (32.5%). BL wereprescribed for tonsillitis in 32.5%, otitis in 21.7% andupper airways infection in 19.3%. Cutaneous lesionswere the most frequently reported (94%) manifestations,with maculopapular exanthema (MPE) being the mostcommon. In 45 reactions (54.2%), the time of onset wasunknown; in 4.8% the reaction was immediate and inthe remaining cases non immediate (41%). In 23 cases(27.7%) there was no history of previous exposure to thesuspected drug; 15 children had previous exposure witha similar reaction. In the group of patients with immediatereactions or unknown time of onset (n=49), determinationof specific IgE (sIgE) for penicillin G, V and amoxicillinwas performed in 43 (87.8%), and skin prick tests in 42patients (85.7%), all with negative results. Of all patients,16 (20%) underwent intradermal testing (IDT) and onlyone patient had a positive result with PPL 1/1; late readingwas done in 3 cases, all negative. Oral provocation test(OPT) with the suspected BL (single or continued athome) was performed in 74 cases (89.2%) with positiveresult in 6 patients (8.1%), all of them exclusively with latecutaneous involvement.DiscussionSuspected BL HSR was only confirmed in 8.1%.Although MPE caused by BL treatment in children israre, there are no clinical distinctive characteristics fromMPE related to infections, making allergy diagnosisworkup mandatory. The authors raise the question ofthe need of sIgE determination and skin testing in lesssevere reactions, instead of performing directly the OPT.
机译：简介β-内酰胺（BL）是最常用的抗生素（AB）类之一。它们经常与超敏反应（HSR）有关，并涉及皮肤。然而，传染性疾病也可能导致皮肤病变，特别是在儿童中，它们构成了BL HSR的重要鉴别诊断。目的是鉴定可疑BL HSR的特征并分析研究人群中过敏反应的发生率。方法我们回顾性回顾了所有儿童的临床数据（<18岁）于2011年至2013年间向我们的过敏科咨询了疑似BL HSR。结果有80名儿童（56.2％的女性）平均年龄为6.7岁（SD = 4.035），评估了83名疑似BLHSR。从反应到临床评估之间的平均时间为3.1年（SD = 3.36）。牵连最多的药物是阿莫西林/克拉维酸盐（54.2％）和阿莫西林（32.5％）。 BL规定扁桃体炎占32.5％，中耳炎占21.7％，上呼吸道感染占19.3％。皮肤病变是最常报告的症状（94％），其中以斑丘疹性皮疹（MPE）最为常见。在45个反应中（54.2％），发病时间未知。在4.8％中，反应是立即发生的，在其他情况下，反应不是立即发生的（41％）。在23例（27.7％）病例中，没有以前曾接触过可疑药物的病史; 15名儿童以前有过类似反应。在有立即反应或发病时间未知的患者中（n = 49），对青霉素G，V和阿莫西林的特异性IgE（sIgE）的测定为43（87.8％），对42例患者的皮肤穿刺试验为（85.7％），所有结果都是负面的。在所有患者中，有16名（20％）接受了皮内测试（IDT），只有1名患者的PPL 1/1结果为阳性。迟读3例，均为阴性。对74例（89.2％）的疑似BL患者进行了一次口服激发试验（OPT），其中6例（8.1％）的阳性结果全部为晚期皮肤受累。 8.1％。尽管由BL治疗引起的MPE在儿童中是罕见的，但MPE没有与感染相关的临床特征，因此必须进行过敏诊断。作者提出了在较轻的反应中需要进行sIgE测定和皮肤测试的问题，而不是直接进行OPT。

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