Abstract
Objective A misdiagnosed “penicillin allergy” is a common problem in childhood. Recently, skipping
skin tests (STs) and performing a direct oral challenge test (OCT) have become an
increasingly common approach in children with suspected β-lactam (BL) allergy. In
our study, we aimed to evaluate the safety and efficacy of OCT without using ST in
children who had a history of hypersensitivity reactions with BL antibiotics.
Materials and Methods We retrospectively evaluated direct OCT outcomes in children with both nonimmediate
and immediate-type reaction history with BL antibiotics. STs were not performed before
the challenge test. The patients were monitored for 4 hours after the challenge and
continued using the drug in two divided doses for 3 days at home.
Results In this study, 72 patients were included, with median age of 7 years (interquartile
range: 4; min: 1 year to max: 16 years), and of these, 56% were male. Forty-five subjects
(63%) reported immediate-type adverse reactions. The most common clinical manifestation
was urticaria/angioedema (51%, n: 37) and maculopapular exanthema in 46% (n: 33) of patients, respectively. The most commonly suspected drug was 71% amoxicillin-clavulanate.
A 3-day OCT without preceding ST was performed in all patients. Only three patients
(4.2%) showed a positive response to the oral drug challenge test. None of these reactions
observed was more severe than index reactions.
Conclusion Performing OCT without STs is a safe and convenient method to exclude BL hypersensitivity
in the pediatric age group.
Keywords
β-lactam hypersensitivity - child - oral challenge - skin tests - drug allergy
