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PATTERNS OF RESPONSE AND DRUGS INVOLVED IN HYPERSENSITIVITY REACTIONS TO BETA-LACTAMS IN CHILDREN.
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  • Isabel Torres-Rojas,
  • Diana Perez,
  • Maria Luisa Somoza-Alvarez,
  • Elisa Haroun Diaz,
  • Ana María Prieto-Moreno Pfeifer,
  • Teodorikez Jimenez-Rodriguez,
  • Javier Fernandez,
  • Miguel Blanca,
  • Gabriela Canto,
  • Natalia Blanca-Lopez
Isabel Torres-Rojas
Hospital Universitario Infanta Leonor
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Diana Perez
Hospital Universitario Infanta Leonor
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Maria Luisa Somoza-Alvarez
Hospital Universitario Infanta Leonor
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Elisa Haroun Diaz
Hospital Universitario Infanta Leonor
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Ana María Prieto-Moreno Pfeifer
Hospital Universitario Infanta Leonor
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Teodorikez Jimenez-Rodriguez
Alicante General University Hospital
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Javier Fernandez
Universidad Miguel Hernández
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Miguel Blanca
Hospital Universitario Infanta Leonor
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Gabriela Canto
Infanta Leonor Hospital
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Natalia Blanca-Lopez
Hospital Universitario Infanta Leonor
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Abstract

Background Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. Methods Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and nonimmediate reactions. The work-up included sIgE, skin testing and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for nonimmediate ones. Results Of the 510 included children, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%). Among nonimmediate reactions (11,4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6–7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities. Conclusions There were few confirmed cases of either type of reaction. Skin testing proved less valuable in nonimmediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have nonimmediate reactions, while clavulanic acid-selectivity was exclusive to the nonimmediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation.

Peer review status:IN REVISION

12 Mar 2021Submitted to Pediatric Allergy and Immunology
21 Mar 2021Reviewer(s) Assigned
10 Apr 2021Review(s) Completed, Editorial Evaluation Pending
03 May 2021Editorial Decision: Revise Major