Direct oral provocation (no skin testing) in low risk patients with suspected penicillin allergy

Although allergy to antibiotics is commonly claimed, true allergy to these drugs is often absent http://buff.ly/1tIbcTl

Suspected hypersensitivity to beta-lactam antibiotics (mostly pencillin derivatives) in children is a frequent cause of consultation. However, such hypersensitivity is rarely confirmed.

This Spanish study used a short protocol for patients at low risk. Low risk was defined as:

- single episode
- mild, non-immediate skin symptoms
- rash after the administration of a beta-lactam antibiotic via the oral route

The patients were subjected to oral provocation (after obtaining of informed consent) without any other prior evaluations (no skin testing).

Patients failing to meet these requirements were studied according to the protocol of the EAACI with:

- specific IgE
- skin testing
- tests done prior to oral provocation

The study with oral provocation was completed in 67 patients, and the short protocol was used in 50 of those patients.

Only one patient showed a positive provocation test, of a delayed and mild nature.

The authors concluded that direct oral provocation in low risk patients is effective and safe in discarding hypersensitivity to betalactam antibiotics.

References:
Short protocol for the study of paediatric patients with suspected beta-lactam antibiotic hypersensitivity and low risk criteria. Moral L, Garde J, Toral T, Fuentes MJ, Marco N. Allergol Immunopathol (Madr). 2011 Mar 21.

Image source: Penicillin nucleus, Wikipedia, GNU Free Documentation License.