背景:缺乏调查皮肤点刺和皮内测试的相对作用的前瞻性研究,血清特异性免疫球蛋白E,以及在诊断报告有β-内酰胺过敏的儿童时延长口服挑战。
目的:为了确定β-内酰胺过敏儿童的皮肤测试和血清特异性免疫球蛋白E的敏感性和特异性,立即和非立即的历史反应。
方法:招募400名父母报告的β-内酰胺过敏儿童进入开放标签前瞻性研究。收集详细的过敏史。那些有医学观察和记录的过敏反应史的人,需要肾上腺素,或SCAR被排除。总的来说,380名儿童接受了所有测试方式和直接挑衅测试。每个孩子都接受了至少三年的随访。
结果:儿童真正的过敏并不常见,8·3%的人对直接挑衅挑战或5天延长的口头挑衅挑战做出了反应。报告头孢菌素过敏或一年内反应的儿童更有可能对直接激发试验作出反应。敏感性,特异性,皮肤试验的阳性预测值为12·5%,直接挑战结果为98·8%和20·0%,4·76%,延长挑战结果为99·0%和25·0%,和6·9%,这两个挑战加在一起为99·0%和40·0%。后续调查显示,5·7%的儿童有轻微的重复反应,2·7%的儿童尽管成功脱标签,仍继续避免罪魁祸首。重新入院的儿童的重新标记率为15%,而重新标记是没有根据的。
结论:真正的β-内酰胺过敏是罕见的,超过90%的儿童有效地脱标签。皮肤和血清特异性免疫球蛋白E检测不能帮助诊断儿童的β-内酰胺类抗生素过敏,不管病史。延长口腔挑战在确认过敏和增强父母信心方面被证明是有价值的。
BACKGROUND: There is a scarcity of prospective studies investigating the relative roles of skin prick and intradermal testing, serum-specific Immunoglobulin E, and extended oral challenges in diagnosing children with reported beta-lactam allergies.
OBJECTIVE: To determine the sensitivity and specificity of skin testing and serum-specific Immunoglobulin E in children with beta-lactam allergies, with immediate and non-immediate historic reactions.
METHODS: Four hundred children with parent-reported beta-lactam allergies were recruited into an open-label prospective study. Detailed allergy histories were collected. Those with medically observed and documented histories of anaphylaxis, requiring epinephrine, or SCARs were excluded. In total, 380 children underwent all testing modalities and a direct provocation test. Each child was followed up for a minimum of three years.
RESULTS: True allergy in children was uncommon, 8·3% reacted to the direct provocation challenge or the 5-day extended oral provocation challenge. Children reporting cephalosporin allergy or a reaction within one year were more likely to react to direct provocation testing. The sensitivity, specificity, and positive predictive value of skin testing was 12·5%, 98·8% and 20·0% for direct challenge outcomes, 4·76%, 99·0% and 25·0% for extended challenge outcomes, and 6·9%, 99·0% and 40·0% for both challenges combined. Follow-up investigations revealed that 5·7% of children had a mild repeat reaction and 2·7% continued to avoid the culprit despite successful delabeling. The
relabeling rate for children readmitted to hospital was 15% with the relabeing being unfounded.
CONCLUSIONS: Genuine beta-lactam allergies were rare, with over 90% of children effectively delabeled. Skin and serum-specific Immunoglobulin E testing did not aid the diagnosis of beta-lactam antibiotic allergy in children, regardless of medical history. Extended oral challenges proved valuable in confirming allergies and boosted parental confidence.