期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
卷 127, 期 1, 页码 218-222出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2010.08.025
关键词
Drug allergy; virus; skin rash; children; penicillin; beta-lactam; cephalosporin; oral challenge; skin test; blood allergy test
资金
- Geneva University Hospitals [06- I 7]
- Swiss National Foundation [3200B 101670]
- Swiss National Foundation
Background: Delayed-onset urticarial or maculopapular rashes are frequently observed in children treated with beta-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 beta-lactams 2 months after presentation. Anti-beta-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, beta-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 beta-lactam. (J Allergy Clin Immunol 2011;127:218-22.)
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