ANTIBIOTIC SKIN TESTING FOR CHILDREN LABELED WITH TYPE 1 HYPERSENSITIVITY: A USEFUL CLINICAL TOOL
INTRODUCTION: Children are often unnecessarily labeled as being allergic to antibiotics that may potentially be life saving. Aside from penicillin, good diagnostic testing has not been available in pediatrics to differentiate between type 1 hypersensitivity and other causes of adverse reactions to antibiotics.
OBJECTIVE: We sought to determine the safety of antibiotic skin testing of children and to describe its potential clinical impact.
METHODS: A retrospective chart review was performed of patients between 0 and 18 years of age who were seen in our clinic over a 2-year period with a history of a possible immunoglobulin E–mediated reaction to various antibiotics other than penicillin. We included patients with either extremely limited antibiotic options or complex medical issues that require antibiotics. We did not perform testing if there was a history of a convincing immunoglobulin E–mediated or serum sickness–like reaction. Skin testing was performed by using nonirritating concentrations of the antibiotic in question that have been used in adults. If skin-prick testing results were negative, we performed intradermal testing. A provocative challenge was offered if all skin-testing results were negative.
RESULTS: of 28 visits, 23 met our inclusion criteria; 4 (17%) of 23 could not be skin-tested. Of those who were skin-prick–tested, all 19 (100%) had a negative result, and 17 (89%) of 19 also had a negative intradermal test. Of those 17 (88%), 15 patients agreed to undergo provocative challenge, 14 (93%) of whom were then unlabeled as allergic to the respective antibiotic.
CONCLUSIONS: Skin-prick testing is a novel tool in pediatrics that may have an important clinical impact in the accurate diagnosis of antibiotic allergies by guiding provocative challenges.
Submitted by Fotini D. Kavadas
- Copyright © 2008 by the American Academy of Pediatrics