title: Non-immediate hypersensitivity reactions to beta-lactam antibiotics in children - our 10-year experience in allergy work-up.
abstract: Non-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as 'drug allergic' after considering only the clinical history.
  
  
  
  To diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL METHODS: A prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae.
  
  
  
  Urticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up.
  
  
  
  A diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs.
authors.affiliation: Medical Faculty, University of Belgrade, Belgrade, Serbia.|University Children's Hospital of Belgrade, Belgrade, Serbia.
authors.forename: Marina
authors.initials: M
authors.lastname: Atanaskovic-Markovic
authors.affiliation: Allergy Unit Complesso Integrato Columbus, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Gaeta
authors.affiliation: Medical Faculty, University of Belgrade, Belgrade, Serbia.|University Children's Hospital of Belgrade, Belgrade, Serbia.
authors.forename: Biljana
authors.initials: B
authors.lastname: Medjo
authors.affiliation: Chemical Faculty University of Belgrade, Belgrade, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Gavrovic-Jankulovic
authors.affiliation: Chemical Faculty University of Belgrade, Belgrade, Serbia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Cirkovic Velickovic
authors.affiliation: University Children's Hospital of Belgrade, Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tmusic
authors.affiliation: Allergy Unit Complesso Integrato Columbus, Rome, Italy.|IRCCS Oasi Maria S.S., Troina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Romano
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005076:Exanthema / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis*; D007223:Infant; D008297:Male; D009177:Mycoplasma pneumoniae / Q000502:physiology*; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis*; D011446:Prospective Studies; D012882:Skin Tests; D014581:Urticaria / Q000175:diagnosis*; D014777:Virus Diseases / Q000175:diagnosis*; D047090:beta-Lactams / Q000276:immunology
chemical_list: D000485:Allergens; D047090:beta-Lactams
keywords: allergy work-up; beta-lactams; children; non-immediate hypersensitivity reactions; provocation test; skin test