title: Direct oral provocation tests in non-immediate mild cutaneous reactions related to beta-lactam antibiotics.
abstract: BACKGROUND
  Skin testing has a limited role in the diagnosis of non-immediate beta-lactam hypersensitivity in children. The aim of this study was to report the results of oral provocation tests performed without skin tests in children with non-immediate mild cutaneous reactions without systemic symptoms caused by beta-lactam antibiotics.
  
  
  METHODS
  Oral provocation tests with suspected antibiotics were performed to patients with non-immediate mild cutaneous reactions without systemic symptoms caused by beta-lactam antibiotics. Skin tests were not performed before provocation tests. A total of five doses were administered with half-an-hour intervals in increasing doses. Provocation was continued for 5 days.
  
  
  RESULTS
  A total of 119 patients with a median age of 4.3 (IQR: 2-7.5) years, of whom 58% were males, were included in the study. Amoxicillin-clavulanic acid was the most frequently responsible agent in 87 (73.1%) patients, and most common type of rash was maculopapular in 74 (62.2%) patients. Four patients (3.4%) had an urticarial reaction during the provocation test.
  
  
  CONCLUSIONS
  We did not experience any severe reactions during oral provocation test without previous skin tests performed to children with non-immediate mild cutaneous reactions without systemic symptoms. Omitting skin tests before oral provocation test in this group of children can help decreasing the burden of allergy clinics and alleviating the discomfort of children.
authors.affiliation: Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Vezir
authors.affiliation: Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Dibek Misirlioglu
authors.affiliation: Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Ersoy
authors.initials: E
authors.lastname: Civelek
authors.affiliation: Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Capanoglu
authors.affiliation: Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Guvenir
authors.affiliation: Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Tayfur
authors.initials: T
authors.lastname: Ginis
authors.affiliation: Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Muge
authors.initials: M
authors.lastname: Toyran
authors.affiliation: Pediatric Allergy and Immunology, Mugla Sitki Kocman University Faculty of Medicine, Mugla, Turkey.
authors.forename: Can N
authors.initials: CN
authors.lastname: Kocabas
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003875:Drug Eruptions / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D007159:Immunologic Tests; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D012882:Skin Tests; D013997:Time Factors; D047090:beta-Lactams / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: beta-lactam antibiotic; children; hypersensitivity; non-immediate reaction; oral provocation test