Direct drug provocation testing for the diagnosis of low-risk pediatric beta-lactam allergy: A risk-stratified retrospective study
Pediatric Allergy and Immunology, cilt.37, sa.4, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 37 Sayı: 4
- Basım Tarihi: 2026
- Doi Numarası: 10.1111/pai.70327
- Dergi Adı: Pediatric Allergy and Immunology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Natural Science Collection (ProQuest), Biological Science Database (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: beta-lactam allergy, children, delayed urticaria, drug provocation test, non-immediate hypersensitivity, penicillin allergy, risk stratification
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Beta-lactam antibiotics remain the most commonly reported cause of drug allergy in children. Skin testing often shows limited sensitivity and logistical challenges, particularly for non-immediate reactions, leading to the adoption of risk-stratified diagnostic algorithms. This retrospective study evaluated the safety and diagnostic performance of a risk-stratified approach in children with suspected beta-lactam hypersensitivity, focusing on low-risk non-immediate phenotypes. Methods: Medical records of 180 children (aged 3–18 years) evaluated for suspected beta-lactam allergy were reviewed. Patients were stratified based on reaction timing and clinical phenotype. Moderate-to-high-risk cases (history of anaphylaxis or immediate reactions) underwent skin testing followed by drug provocation test (DPT) if skin tests were negative. Low-risk cases (mild maculopapular exanthema [MPE] or benign delayed-onset urticaria occurring >6 h after dosing and lasting >24 h) underwent direct oral DPT without prior skin testing. Results: Beta-lactam hypersensitivity was confirmed in 15.6% (28/180) of patients, with higher confirmation rates in immediate reactions (21.1%) compared to non-immediate reactions (3.5%). Among 57 low-risk non-immediate patients who underwent direct DPT, only 2 (3.5%) experienced mild, self-resolving cutaneous reactions; no systemic or severe reactions were observed. No positive reactions occurred in patients with delayed-onset urticaria (>6 h post-dose). Conclusion: Risk stratification based on detailed clinical history provides a safe and effective strategy for evaluating suspected beta-lactam hypersensitivity in children. Direct oral DPT without preceding skin testing is safe and efficient for low-risk non-immediate phenotypes, including mild MPE and benign delayed-onset urticaria, and should be more widely implemented to facilitate timely delabeling.