Most Children Do Not Have Positive Results to Antibiotic Challenge

Most children with non-β-lactam antibiotic (NBLA) allergy can be delabeled, with positive results on allergy testing for only 18 percent, according to a study published online December in Pediatrics.

Lisa Grinlington, M.B.B.S., from the Royal Children's Hospital Melbourne in Australia, and colleagues describe the results of allergy evaluation among children with a suspected NBLA allergy who had skin testing and/or an intravenous or oral challenge test between May 2011 and June 2018.

A total of 141 children had 150 allergy evaluations of 15 different NBLAs over the seven-year study period. The researchers found that time from the initial reported reaction to allergy evaluation was a median of 1.9 years. Overall, positive results were seen for 27 of 150 (18 percent) challenge tests to NBLAs, with the rate of positive oral challenge tests highest for trimethoprim-sulfamethoxazole and macrolides (32.6 and 10.4 percent, respectively). Initial anaphylactic reactions were reported for four children; however, no patients had severe symptoms on rechallenge or required adrenaline. Most children (23 of 27) with challenges with positive results had similar symptoms on repeat challenges to those initially reported.

"Our study also highlights the significant delay in the testing and delabeling of NBLA allergy in children," the authors write. "Improved access to standardized and reliable allergy testing protocols to delabel children are urgently needed."

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