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. 2011 Jan;127(1):218-22.
doi: 10.1016/j.jaci.2010.08.025. Epub 2010 Oct 28.

The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge

Jean-Christoph Caubet  1 , Laurent Kaiser, Barbara Lemaître, Benoît Fellay, Alain Gervaix, Philippe A Eigenmann
Affiliations

The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge

Jean-Christoph Caubet et al. J Allergy Clin Immunol. 2011 Jan.

Abstract

Background: Delayed-onset urticarial or maculopapular rashes are frequently observed in children treated with β-lactams. Many are labeled "allergic" without reliable testing.

Objective: Determine the etiology of these rashes by exploring both infectious and allergic causes.

Methods: Children presenting to the emergency department with delayed-onset urticarial or maculopapular rashes were enrolled. Acute and convalescent sera were obtained for viral screening along with a throat swab. Subjects underwent intradermal and patch skin testing for β-lactams 2 months after presentation. Anti-β-lactam blood allergy tests were also obtained. All subjects underwent an oral challenge test (OCT) with the culprit antibiotic.

Results: Eighty-eight children were enrolled between 2006 and 2008. There were 11 (12.5%) positive intradermal and no positive patch tests. There were 2 (2.3%) positive blood allergy tests. There were 6 (6.8%) subjects with a positive OCT, 2 were intradermal-negative, and 4 were intradermal-positive. No OCT reactions were more severe than the index event. Most subjects had at least 1 positive viral study, 54 (65.9%) in the OCT negative group.

Conclusion: In this situation, β-lactam allergy is clearly overdiagnosed because the skin rash is only rarely reproducible (6.8%) by a subsequent challenge. Viral infections may be an important factor in many of these rashes. OCTs were positive in a minority of intradermal skin test-positive subjects. Patch testing and blood allergy testing provided no useful information. OCTs should be considered in all children who develop a delayed-onset urticarial or maculopapular rash during treatment with a β-lactam.

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Comment in

  • Retesting in children with β-lactam allergy.
    Matheu V, Iglesias-Souto J, González R, Poza P, Sanchez-Machín I. Matheu V, et al. J Allergy Clin Immunol. 2011 Aug;128(2):429; author reply 429-30. doi: 10.1016/j.jaci.2011.04.041. Epub 2011 May 18. J Allergy Clin Immunol. 2011. PMID: 21596422 No abstract available.
  • A suspicion of antibiotic allergy in children is often incorrect.
    Mattheij M, de Vries E. Mattheij M, et al. J Allergy Clin Immunol. 2012 Feb;129(2):583; author reply 583-4. doi: 10.1016/j.jaci.2011.11.027. Epub 2011 Dec 22. J Allergy Clin Immunol. 2012. PMID: 22196770 Free PMC article. No abstract available.

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