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Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool

BACKGROUND: Diagnostic testing to antibiotics other than to penicillin has not been widely available, making the diagnosis of antibiotic allergy difficult and often erroneous. There is often reluctance in performing challenges to antibiotics when standardized testing is lacking. However, while the i...

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Autores principales: Kavadas, Fotini D, Kasprzak, Anna, Atkinson, Adelle R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687567/
https://www.ncbi.nlm.nih.gov/pubmed/23767685
http://dx.doi.org/10.1186/1710-1492-9-22
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author Kavadas, Fotini D
Kasprzak, Anna
Atkinson, Adelle R
author_facet Kavadas, Fotini D
Kasprzak, Anna
Atkinson, Adelle R
author_sort Kavadas, Fotini D
collection PubMed
description BACKGROUND: Diagnostic testing to antibiotics other than to penicillin has not been widely available, making the diagnosis of antibiotic allergy difficult and often erroneous. There is often reluctance in performing challenges to antibiotics when standardized testing is lacking. However, while the immunogenic determinants are not known for most antibiotics, a skin reaction at a non-irritating concentration (NIC) may mean that antibodies to the native form are present in the circulation. While the NIC’s for many non penicillin antibiotics have been determined in adults, the use of these concentrations for skin testing pediatric subjects prior to provocative challenge has not been done. Our objective was to determine if we could successfully uncover the true nature of antibiotic allergy in children using these concentrations for testing. METHODS: Children were included between 2003–2009 upon being referred to the Drug and Adverse Reaction/Toxicology (DART) clinic of the Hospital for Sick Children in Toronto, Ontario Canada. The referral needed to demonstrate that clinical care was being compromised by the limitation in antibiotic options or there was a significant medical condition for which the label of antibiotic allergy may prove detrimental. Patients were not seen if there was a suggestion of serum like sickness, Stevens Johnson Syndrome or Toxic Epidermal Necrolysis. Patients were excluded from testing if there was objective evidence of anaphylaxis. All other patients were consented to receive testing and/or challenges. A retrospective chart review was then performed of the results. RESULTS: We were able to exclude an antibiotic allergy in the majority of our patients who had a negative intradermal test result and were then challenged (>90%). Only one patient was challenged with a positive intradermal test to Cotrimoxazole because of a questionable history and this patient failed the provocative challenge. While we did not challenge more patients with positive testing, we did note that 10/11 (91%) patients with positive intradermal testing had some aspect of a Type 1 reaction in their history. CONCLUSIONS: Through testing with NIC’s of various antibiotics in children and providing provocative challenges based on negative skin testing results, we were able to advance the medical care of the majority of our patients by increasing their antibiotic options in order to successfully treat future infections. While challenging patients with positive testing was not deemed ethically appropriate at this stage of our study, it would be a useful future step to reaching statistical validity of testing to these antibiotics.
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spelling pubmed-36875672013-06-21 Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool Kavadas, Fotini D Kasprzak, Anna Atkinson, Adelle R Allergy Asthma Clin Immunol Letter to the Editor BACKGROUND: Diagnostic testing to antibiotics other than to penicillin has not been widely available, making the diagnosis of antibiotic allergy difficult and often erroneous. There is often reluctance in performing challenges to antibiotics when standardized testing is lacking. However, while the immunogenic determinants are not known for most antibiotics, a skin reaction at a non-irritating concentration (NIC) may mean that antibodies to the native form are present in the circulation. While the NIC’s for many non penicillin antibiotics have been determined in adults, the use of these concentrations for skin testing pediatric subjects prior to provocative challenge has not been done. Our objective was to determine if we could successfully uncover the true nature of antibiotic allergy in children using these concentrations for testing. METHODS: Children were included between 2003–2009 upon being referred to the Drug and Adverse Reaction/Toxicology (DART) clinic of the Hospital for Sick Children in Toronto, Ontario Canada. The referral needed to demonstrate that clinical care was being compromised by the limitation in antibiotic options or there was a significant medical condition for which the label of antibiotic allergy may prove detrimental. Patients were not seen if there was a suggestion of serum like sickness, Stevens Johnson Syndrome or Toxic Epidermal Necrolysis. Patients were excluded from testing if there was objective evidence of anaphylaxis. All other patients were consented to receive testing and/or challenges. A retrospective chart review was then performed of the results. RESULTS: We were able to exclude an antibiotic allergy in the majority of our patients who had a negative intradermal test result and were then challenged (>90%). Only one patient was challenged with a positive intradermal test to Cotrimoxazole because of a questionable history and this patient failed the provocative challenge. While we did not challenge more patients with positive testing, we did note that 10/11 (91%) patients with positive intradermal testing had some aspect of a Type 1 reaction in their history. CONCLUSIONS: Through testing with NIC’s of various antibiotics in children and providing provocative challenges based on negative skin testing results, we were able to advance the medical care of the majority of our patients by increasing their antibiotic options in order to successfully treat future infections. While challenging patients with positive testing was not deemed ethically appropriate at this stage of our study, it would be a useful future step to reaching statistical validity of testing to these antibiotics. BioMed Central 2013-06-14 /pmc/articles/PMC3687567/ /pubmed/23767685 http://dx.doi.org/10.1186/1710-1492-9-22 Text en Copyright © 2013 Kavadas et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Letter to the Editor
Kavadas, Fotini D
Kasprzak, Anna
Atkinson, Adelle R
Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool
title Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool
title_full Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool
title_fullStr Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool
title_full_unstemmed Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool
title_short Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool
title_sort antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool
topic Letter to the Editor
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687567/
https://www.ncbi.nlm.nih.gov/pubmed/23767685
http://dx.doi.org/10.1186/1710-1492-9-22
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