The use of direct oral challenge to confirm allergies to penicillin class antibiotics in Danish children
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(2020) 20:523
RESEARCH ARTICLE
Open Access
The use of direct oral challenge to confirm allergies to penicillin class antibiotics in Danish children Thomas Krusenstjerna-Hafstrøm1*
and Sune Rubak1,2
Abstract Background: A high number of children are referred to pediatric departments with a suspected allergic reaction to antibiotics. The prevalence of true allergy is considered to be significantly lower than shown from clinical history and symptoms alone. This study investigated the historical use of direct oral challenges at three specialist pediatric departments in Denmark. Methods: In this retrospective medical record review study, 141 children (69 boys and 72 girls) with a clinical history of suspected penicillin class allergy were investigated. A standardized questionnaire for drug allergy was completed in the beginning of the investigation, which also included a skin prick test (SPT), measurement of IgE to different types of penicillin, and a drug challenge (DC). Results: Only four (2.8%) of the patients referred for further investigation in our study had a positive DC. We found no correlation between a positive DC, positive SPT or elevated specific IgE. None of the patients with a positive DC reacted with a rash alone prior to investigation. Conclusions: Allergy to penicillin in children is rare and probably overestimated. In children reacting to penicillin with a rash alone, our study indicated that the rash was probably not related to allergy and treatment should thus be continued.
Background Only a small minority of children with suspected IgEmediated allergy to penicillin is confirmed to be hypersensitive in direct oral challenge, which is the current reference standard. This study investigates the historical use of direct oral challenges at three specialist pediatric departments in Denmark. We speculated that most of the children referred with allergy to penicillin would show not to be. Many children are referred to pediatric departments with a suspected allergic reaction to antibiotics. The prevalence of true allergy is considered to be * Correspondence: [email protected] 1 Department of Paediatric and Adolescents Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark Full list of author information is available at the end of the article
significantly lower than indicated from the clinical history and symptoms alone. Among children, allergic reactions have been reported with an incidence as high as 10% of all prescriptions for antibiotics [1, 2]. However, drug-related side effects or disease-related symptoms are often mistaken for being an allergic reaction to antibiotics [3]. Examples of this are low risk symptoms, such as rashes or itching, which are rarely related to allergic reactions [4]. A large study from 2016 at the allergy clinic of the Montreal Children’s Hospital showed that among 818 patients suspected for amoxicillin allergy, only 5.8% tested positive in a graded drug challenge (DC) [5]. Penicillin is among the most commonly used antibiotics in child
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