title: Lack of uniformity in the investigation and management of suspected β-lactam allergy in children.
abstract: Beta-lactam allergy is commonly suspected in childhood with health implications for the individual and wider public. Diagnostic modalities include skin prick tests (SPT), specific immunoglobulin-E (sp-IgE) tests, intradermal tests (IDT) and drug provocation challenges (DPC). The aim of this research was to establish whether variation exists around the world in the investigation and management of beta-lactam allergy.
  
  
  
  Anonymized electronic questionnaire surveys were distributed over 3 months through International Allergy Societies for completion by clinicians who investigate drug allergy in children.
  
  
  
  Eighty-one clinicians, practising in 16 countries, completed the questionnaire. There is variability in the selection of diagnostic tests used by clinicians around the world and poor agreement on positive cut-off values (sp-IgE, SPT and IDT) and practical techniques used to measure SPT or IDT wheal diameters. DPC were considered the gold standard investigation with 94% of respondents undertaking DPC over the last 12 months; 64% of respondents considered DPC extremely useful for both exclusion and confirmation of beta-lactam allergy. However, there is a lack of consensus on when and how DPC should be performed. Overall, DPC are safe - only 3% of our respondents had patients who required intramuscular adrenaline and none had patients requiring admission to intensive care.
  
  
  
  There is lack of consistency amongst clinicians in different countries in the diagnosis and management of suspected beta-lactam allergy. The development of a standardized approach is a priority.
authors.affiliation: Department of Paediatric Allergy, Guys and St. Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: Ru-Xin Melanie
authors.initials: RX
authors.lastname: Foong
authors.affiliation: Department of Paediatric Allergy, Guys and St. Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Logan
authors.affiliation: Population Health Research Institute, St. George's University of London, London, UK.
authors.forename: Michael Richard
authors.initials: MR
authors.lastname: Perkin
authors.affiliation: Department of Paediatric Allergy, Guys and St. Thomas' Hospitals NHS Foundation Trust, London, UK.|Division of Asthma, Allergy and Lung Biology, Department of Allergy, King's College London, St. Thomas' Hospital, London, UK.
authors.forename: George
authors.initials: G
authors.lastname: du Toit
mesh_terms: D000284:Administration, Oral; D000465:Algorithms; D000485:Allergens / Q000276:immunology*; D000072223:Allergists; D002648:Child; D032921:Consensus; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology*; D005060:Europe; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D011364:Professional Practice / Q000706:statistics & numerical data*; D012882:Skin Tests; D011795:Surveys and Questionnaires; D047090:beta-Lactams / Q000276:immunology*
chemical_list: D000485:Allergens; D047090:beta-Lactams; D007073:Immunoglobulin E
keywords: beta-lactam allergy; diagnostic procedures; drug provocation test; paediatric