title: Diagnostic evaluation of hypersensitivity reactions to beta-lactam antibiotics in a large population of children.
abstract: BACKGROUND
  Hypersensitivity reactions to beta-lactams (BLs) are often reported in children, with amoxicillin and, to a lesser extent, cephalosporins being the most frequent drugs involved. Although many of these children are considered to be allergic, a careful evaluation only confirms a low percentage.
  
  
  OBJECTIVE
  To analyse the clinical data, sensitization profile and diagnostic methods used in a large group of children with a clinical history of hypersensitivity reactions to BLs.
  
  
  METHODS
  The study included children aged 1-14 yr with symptoms suggestive of hypersensitivity to BLs from January 2006-December 2012. Diagnosis was confirmed from a clinical history, specific IgE determination, skin testing and, if necessary, a drug provocation test (DPT).
  
  
  RESULTS
  Of a total of 783 patients studied, only 62 (7.92%) were confirmed as being allergic, 9 (14.52%) with immediate and 53 (85.48%) with non-immediate reactions. In those with immediate reactions, 2 (22.22%) were diagnosed by in vitro test, 2 (22.22%) by skin testing and 5 (55.56%) by DPT; in those with non-immediate reactions, 2 (3.77%) were diagnosed by skin testing and 51 (96.23%) by DPT. In all cases, DPT was positive to the culprit drug (29 AX-CLV, 26 AX, 1 cefixime and 1 cefaclor), and the most usual symptoms were exanthema in 43 cases, urticaria in 12, urticaria-angio-oedema in 1 and erythema in 1 case.
  
  
  CONCLUSIONS
  After an allergological work-up, over 90% of the children evaluated were finally confirmed as tolerant to BLs. Most reactions were of the non-immediate type, and DPT was an essential tool for diagnosis.
authors: Paediatric Service, Carlos Haya Hospital, Málaga, Spain.
authors: Maria A
authors: MA
authors: Zambonino
authors: Jose Luis
authors: JL
authors: Corzo
authors: Candelaria
authors: C
authors: Muñoz
authors: Gloria
authors: G
authors: Requena
authors: Adriana
authors: A
authors: Ariza
authors: Cristobalina
authors: C
authors: Mayorga
authors: Antonio
authors: A
authors: Urda
authors: Miguel
authors: M
authors: Blanca
authors: M J
authors: MJ
authors: Torres
mesh_terms: D000293:Adolescent; D000658:Amoxicillin / Q000008:administration & dosage / Q000009:adverse effects; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D005076:Exanthema / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D008297:Male; D044382:Population Groups; D012882:Skin Tests; D047090:beta-Lactams / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D002511:Cephalosporins; D047090:beta-Lactams; D007073:Immunoglobulin E; D000658:Amoxicillin
keywords: IgE; beta-lactams; children; drug provocation test; hypersensitivity; skin test