1. Efficacy and Safety of 5-Day Challenge for the Evaluation of Nonsevere Amoxicillin Allergy in Children
- Author
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Jonathan Lacombe-Barrios, François Graham, Philipps Bégin, Louis Paradis, Kathryn Samaan, Roxane Labrosse, Anne Des Roches, and Jean Paradis
- Subjects
Male ,medicine.medical_specialty ,Allergy ,Adolescent ,medicine.drug_class ,Antibiotics ,Provocation test ,Drug allergy ,Context (language use) ,Penicillins ,Severity of Illness Index ,Drug Hypersensitivity ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,polycyclic compounds ,otorhinolaryngologic diseases ,medicine ,Humans ,Immunology and Allergy ,Child ,business.industry ,Amoxicillin ,Infant ,Allergens ,medicine.disease ,Penicillin ,Treatment Outcome ,030228 respiratory system ,Child, Preschool ,Ambulatory ,Female ,Immunization ,business ,Follow-Up Studies ,medicine.drug - Abstract
Background Penicillin allergy is the most frequent drug allergy, among which aminopenicillins are reputed for causing delayed rashes in children, particularly in the context of viral infections. Despite a negative allergy evaluation, a significant proportion of individuals continue to avoid penicillin antibiotics for fear of an allergic reaction. Objective To evaluate the safety and efficacy of a 5-day challenge to amoxicillin and the proportion of subsequent use of amoxicillin. Methods Pediatric patients with a history of a reaction to amoxicillin were prospectively recruited in the study. All patients were challenged, and those with negative immediate challenges underwent an ambulatory 5-day challenge to amoxicillin to rule out nonimmediate reactions. Patients were called 2 years after their initial allergy evaluation to assess subsequent amoxicillin use and tolerance. Results One hundred thirty children with a history of amoxicillin allergy underwent a graded drug provocation test (DPT) to amoxicillin. Three patients had a positive immediate challenge, 3 had a positive nonimmediate challenge, and 2 were equivocal. Of the 122 patients with a negative challenge, 114 (93.4%) were reached 2 years after their initial allergy evaluation: 75 had used antibiotics since, of which only 1 (1.3%) had refused to reuse amoxicillin because of fear of an allergic reaction. Finally, the 5-day DPT resulted in a 24.1% decrease in future penicillin avoidance compared with classical single-dose graded DPT performed for 1 day in a historical cohort (P Conclusion The 5-day challenge is a safe and effective way to rule out nonimmediate amoxicillin allergy, and it ensures better compliance with future penicillin use.
- Published
- 2018
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