title: Drug provocation tests to betalactam antibiotics: experience in a paediatric setting.
abstract: BACKGROUND
  Few studies have been performed in children with suspected betalactam allergy. We aimed to assess the role of the drug provocation test (DPT) with betalactams in a paediatric setting and to study the association between allergy to betalactam antibiotics and other allergic diseases.
  
  
  METHODS
  We included all the patients under 15 years old who were consecutively referred to the Immunoallergy Department, Dona Estefânia Hospital, Portugal (January 2002 to April 2008) for a compatible history of allergic reaction to betalactam. All were submitted to a DPT. Children were proposed to perform skin tests (ST) to betalactam antibiotics followed by DPT. If they decline ST, a DPT with the culprit drug was performed.
  
  
  RESULTS
  We studied 161 children, 60% were boys, with a median age of 5 years old at the time of the DPT. Thirty-three patients (20.5%) had an immediate reaction and 33 (20.5%) a non-immediate reaction. The severity of the reported reactions was low in most cases. Skin tests to betalactams were performed in 47 children and were positive in 8. DPT was positive in only one (3.4%) of the patients skin tested and in 11 (13.4%) of those not skin tested. The severity of the DPT reaction was low. Asthma and food allergy were associated with a positive DPT in the later group.
  
  
  CONCLUSIONS
  DPT seems a safe procedure even in the absence of ST in non-severe cases. This could be a practical option in infants and pre-school children, where ST are painful and difficult to perform. Additional caution should be taken in children with asthma and food allergy.
authors.affiliation: Immunoallergy Department, Dona Estefânia Hospital, Lisbon Central Hospital, Portugal. chambel.marta@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Chambel
authors.forename: P
authors.initials: P
authors.lastname: Martins
authors.forename: I
authors.initials: I
authors.lastname: Silva
authors.forename: S
authors.initials: S
authors.lastname: Palma-Carlos
authors.forename: A M
authors.initials: AM
authors.lastname: Romeira
authors.forename: P
authors.initials: P
authors.lastname: Leiria Pinto
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage / Q000627:therapeutic use; D001985:Bronchial Provocation Tests; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D007114:Immunization; D008297:Male; D011174:Portugal; D047090:beta-Lactams / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000485:Allergens; D047090:beta-Lactams