Daijiworld Media Network - Singapore
Singapore, Aug 17: Most children labelled as allergic to beta-lactam antibiotics may not have a confirmed hypersensitivity, with a new study finding that direct oral drug provocation testing (DPT) safely removed the allergy label in the majority of carefully selected children.
The study found that direct oral DPT could be used in children with suspected beta-lactam hypersensitivity, including those with mild immediate and delayed reactions, potentially reducing the need for preceding skin testing.
Beta-lactam antibiotics, which include penicillins, cephalosporins, carbapenems and monobactams, are commonly suspected of causing allergic reactions in children. However, many reported allergies may instead be related to viral rashes or side effects of antibiotics.
An allergy label acquired during childhood can persist for years and may restrict access to first-line antibiotics, leading doctors to prescribe broader-spectrum alternatives. Such unnecessary use of broader antibiotics can contribute to antimicrobial resistance.
International guidelines already recommend direct DPT for children with mild, delayed hypersensitivity reactions, where the suspected antibiotic is administered under medical supervision without prior skin testing.
However, uncertainty has remained over whether the same approach is safe for children who have experienced mild immediate reactions and whether evidence largely based on Western populations can be applied to Asian children.
Researchers from Singapore's Ministry of Health Holdings and the Allergy Service at KK Women's and Children's Hospital retrospectively reviewed 395 children who underwent 425 beta-lactam DPTs for suspected hypersensitivity reactions. Some children underwent skin testing before the drug challenge, while others underwent direct oral DPT.
Among diagnostic direct oral DPTs involving the suspected beta-lactam antibiotic, 89.3% were successfully completed, allowing the children to have their beta-lactam allergy labels removed.
Of the reactions recorded during diagnostic direct oral DPTs, 88.9% were mild skin reactions. Three cases, or 8.3%, involved cytokine release syndrome, while one case, accounting for 2.8%, involved anaphylaxis.
The researchers found that a younger age at the time of the original suspected reaction was the only statistically significant factor associated with successfully passing a diagnostic direct oral DPT.
The researchers concluded that direct oral DPT was a safe method for removing beta-lactam allergy labels in appropriately selected children with mild immediate or delayed hypersensitivity histories.
The findings support consideration of direct DPT in carefully selected children and could potentially reduce reliance on skin testing during allergy evaluation.
However, the researchers stressed that the study should not be interpreted as supporting direct drug challenges in children with severe immediate reactions, previous severe cutaneous adverse reactions or other high-risk allergy histories.
The study was retrospective and was conducted in Singapore, meaning its findings should be interpreted within those limitations.
Researchers said the findings nevertheless add important evidence from an Asian paediatric population to the growing body of research supporting risk-stratified evaluation of suspected beta-lactam allergies.
For appropriately selected children, direct oral DPT may therefore offer a useful way to remove unnecessary antibiotic allergy labels and preserve access to suitable first-line treatments.