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Non-immediate hypersensitivity reactions to beta-lactam antibiotics in children : our 10-year experience in allergy work-up

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Abstract
Background: Non-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as drug allergic' after considering only the clinical history. Objective: To diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL Methods: A prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae. Results: Urticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up. Conclusions: A diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs.
Keywords
allergy work-up, beta-lactams, children, non-immediate hypersensitivity reactions, provocation test, skin test, DRUG HYPERSENSITIVITY, GENERAL-CONSIDERATIONS, DIAGNOSIS, SKIN, CEPHALOSPORINS, PROVOCATION, IMMEDIATE, ADULTS, RASHES, TESTS

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Chicago
Atanaskovic-Markovic, Marina, Francesco Gaeta, Biljana Medjo, Marija Gavrovic-Jankulovic, Tanja Cirkovic Velickovic, Vladimir Tmusic, and Antonino Romano. 2016. “Non-immediate Hypersensitivity Reactions to Beta-lactam Antibiotics in Children : Our 10-year Experience in Allergy Work-up.” Pediatric Allergy and Immunology 27 (5): 533–538.
APA
Atanaskovic-Markovic, M., Gaeta, F., Medjo, B., Gavrovic-Jankulovic, M., Cirkovic Velickovic, T., Tmusic, V., & Romano, A. (2016). Non-immediate hypersensitivity reactions to beta-lactam antibiotics in children : our 10-year experience in allergy work-up. PEDIATRIC ALLERGY AND IMMUNOLOGY, 27(5), 533–538.
Vancouver
1.
Atanaskovic-Markovic M, Gaeta F, Medjo B, Gavrovic-Jankulovic M, Cirkovic Velickovic T, Tmusic V, et al. Non-immediate hypersensitivity reactions to beta-lactam antibiotics in children : our 10-year experience in allergy work-up. PEDIATRIC ALLERGY AND IMMUNOLOGY. 2016;27(5):533–8.
MLA
Atanaskovic-Markovic, Marina, Francesco Gaeta, Biljana Medjo, et al. “Non-immediate Hypersensitivity Reactions to Beta-lactam Antibiotics in Children : Our 10-year Experience in Allergy Work-up.” PEDIATRIC ALLERGY AND IMMUNOLOGY 27.5 (2016): 533–538. Print.
@article{8527355,
  abstract     = {Background: Non-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as drug allergic' after considering only the clinical history. 
Objective: To diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL 
Methods: A prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae. 
Results: Urticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4\%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up. 
Conclusions: A diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5\%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs.},
  author       = {Atanaskovic-Markovic, Marina and Gaeta, Francesco and Medjo, Biljana and Gavrovic-Jankulovic, Marija and Cirkovic Velickovic, Tanja and Tmusic, Vladimir and Romano, Antonino},
  issn         = {0905-6157},
  journal      = {PEDIATRIC ALLERGY AND IMMUNOLOGY},
  language     = {eng},
  number       = {5},
  pages        = {533--538},
  title        = {Non-immediate hypersensitivity reactions to beta-lactam antibiotics in children : our 10-year experience in allergy work-up},
  url          = {http://dx.doi.org/10.1111/pai.12565},
  volume       = {27},
  year         = {2016},
}

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