TY - JOUR
T1 - Lack of uniformity in the investigation and management of suspected β-lactam allergy in children
AU - Foong, Ru Xin Melanie
AU - Logan, Kirsty
AU - Perkin, Michael Richard
AU - du Toit, George
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background: Beta-lactam allergy is commonly suspected in childhood with health implications for the individual and wider public. Diagnostic modalities include skin prick tests (SPT), specific immunoglobulin-E (sp-IgE) tests, intradermal tests (IDT) and drug provocation challenges (DPC). The aim of this research was to establish whether variation exists around the world in the investigation and management of beta-lactam allergy. Methods: Anonymized electronic questionnaire surveys were distributed over 3 months through International Allergy Societies for completion by clinicians who investigate drug allergy in children. Results: Eighty-one clinicians, practising in 16 countries, completed the questionnaire. There is variability in the selection of diagnostic tests used by clinicians around the world and poor agreement on positive cut-off values (sp-IgE, SPT and IDT) and practical techniques used to measure SPT or IDT wheal diameters. DPC were considered the gold standard investigation with 94% of respondents undertaking DPC over the last 12 months; 64% of respondents considered DPC extremely useful for both exclusion and confirmation of beta-lactam allergy. However, there is a lack of consensus on when and how DPC should be performed. Overall, DPC are safe – only 3% of our respondents had patients who required intramuscular adrenaline and none had patients requiring admission to intensive care. Conclusions: There is lack of consistency amongst clinicians in different countries in the diagnosis and management of suspected beta-lactam allergy. The development of a standardized approach is a priority.
AB - Background: Beta-lactam allergy is commonly suspected in childhood with health implications for the individual and wider public. Diagnostic modalities include skin prick tests (SPT), specific immunoglobulin-E (sp-IgE) tests, intradermal tests (IDT) and drug provocation challenges (DPC). The aim of this research was to establish whether variation exists around the world in the investigation and management of beta-lactam allergy. Methods: Anonymized electronic questionnaire surveys were distributed over 3 months through International Allergy Societies for completion by clinicians who investigate drug allergy in children. Results: Eighty-one clinicians, practising in 16 countries, completed the questionnaire. There is variability in the selection of diagnostic tests used by clinicians around the world and poor agreement on positive cut-off values (sp-IgE, SPT and IDT) and practical techniques used to measure SPT or IDT wheal diameters. DPC were considered the gold standard investigation with 94% of respondents undertaking DPC over the last 12 months; 64% of respondents considered DPC extremely useful for both exclusion and confirmation of beta-lactam allergy. However, there is a lack of consensus on when and how DPC should be performed. Overall, DPC are safe – only 3% of our respondents had patients who required intramuscular adrenaline and none had patients requiring admission to intensive care. Conclusions: There is lack of consistency amongst clinicians in different countries in the diagnosis and management of suspected beta-lactam allergy. The development of a standardized approach is a priority.
KW - beta-lactam allergy
KW - diagnostic procedures
KW - drug provocation test
KW - paediatric
UR - http://www.scopus.com/inward/record.url?scp=84978216563&partnerID=8YFLogxK
U2 - 10.1111/pai.12557
DO - 10.1111/pai.12557
M3 - Article
C2 - 26920651
AN - SCOPUS:84978216563
SN - 0905-6157
VL - 27
SP - 527
EP - 532
JO - Pediatric Allergy and Immunology
JF - Pediatric Allergy and Immunology
IS - 5
ER -