RESUMEN
BACKGROUND: Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use. OBJECTIVE: To assess the accuracy of tools for diagnosis of penicillin allergy in children. METHODS: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs). RESULTS: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; Pâ¯=â¯.008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; Pâ¯=â¯.004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; Pâ¯=â¯.007). CONCLUSION: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children.
Asunto(s)
Antibacterianos/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Penicilinas/efectos adversos , Administración Oral , Antibacterianos/uso terapéutico , Niño , Preescolar , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Inmunización , Inmunoglobulina E/sangre , Masculino , Anamnesis , Penicilinas/uso terapéutico , Estudios Prospectivos , Pruebas CutáneasRESUMEN
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Asunto(s)
Humanos , Masculino , Femenino , Asma/epidemiología , Asma/prevención & control , Estado Asmático/epidemiología , Estado Asmático/prevención & control , Sociedades Médicas/normas , Sociedades Médicas/tendencias , Sociedades Médicas , Asma/inmunología , Estado Asmático/inmunología , Sociedades Médicas/historia , Sociedades Médicas/organización & administraciónRESUMEN
A pesar de la elevada prevalencia del asma y, en general, de las enfermedades alérgicas y de la existencia de buenas descripciones clínicas de estos procesos desde la Antigüedad, no ha sido hasta mediados del pasado siglo xx cuando se ha empezado a vislumbrar su patofisiología. El descubrimiento de la inmunoglobulina de clase E por el matrimonio Ishizaka representó un paso de gigante en el conocimiento, no sólo de los mecanismos patofisiológicos, sino también en el diagnóstico y el tratamiento de estas enfermedades (AU)
Despite the high prevalence of asthma and of allergic diseases in general, as well as the existence of high-quality clinical descriptions of these processes over the past centuries, the physiopathology of these diseases only began to be understood in the middle of the twentieth century. The Ishizakas discovery of IgE represented a giant step forward in our knowledge not only of the physiopathological mechanisms of these diseases but also in their diagnosis and treatment (AU)
