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. 2021 Sep 24;55(3):374-381.
doi: 10.14744/SEMB.2021.24434. eCollection 2021.

β-Lactam Allergy in Children

Ayse Suleyman  1 , Ahmet İlhan Yararli  2 , Esra Yucel  1 , Zeynep Tamay  1 , Nermin Guler  1
Affiliations

β-Lactam Allergy in Children

Ayse Suleyman et al. Sisli Etfal Hastan Tip Bul. .

Abstract

Objective: β-lactam antibiotic allergy is the most common drug allergy in children. Most of the patients with suspected reactions to β-lactam antibiotics can actually tolerate these drugs. The aim of this study is to evaluate clinical and laboratory characteristics of children with β-lactam allergy and to determine cross-reactivity between penicillin and cephalosporins.

Methods: The diagnosis of β-lactam allergy was made based on the results of skin tests and/or drug provocation tests (DPT). Penicillin allergy skin tests were performed with DAP penicillin® (Diater laboratories, Madrid, Spain), penicillin G, and ampicillin/amoxicillin preparations. Skin and provocation tests were performed with the culprit cephalosporin in addition to the penicillin skin and/or provocation tests to evaluate cephalosporin allergy.

Results: We found that 87.7% (71/81) of patients with β-lactam allergy were able to tolerate the culprit drug. Among ten patients with confirmed diagnosis, two had cross-reactivity (penicillin and cephalosporin) and 8 had a various β-lactam (aminopenicillin n=6, ceftriaxone n=2) allergies. We identified older age and early-type clinical reactions as risk factors for a confirmed β-lactam allergy.

Conclusion: Skin tests and DPT appear to be useful procedures in the diagnosis, and determination of an alternative safe antibiotic in patients with β-lactam allergy. Most of the patients tolerated the drugs. A minority of the patients with confirmed allergy should avoid all β-lactam antibiotics due to the probability of cross-reactivity.

Keywords: Beta-lactams; cross-reactions; drug allergy; skin tests.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Diagnostic approach and test results for patients with suspected beta-lactam allergy. *There is urticaria with amoxicillin-clavulanate in the history. Positive in prick stage with minor determinant. AM: Amoxicillin, AMP: Ampicillin, AMC: Amoxicillin-clavulanate, AMP-S: Ampicillin-sulbactam. BPG: Benzathine penicillin G, CRO: Ceftriaxone, CXM: Cefuroxime; MD: Major determinants, Md: Minor determinant, PV: Penicillin V, DPT: Drug provocation tests, Penicillin V.
See this image and copyright information in PMC

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