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Original research
Allergy to beta-lactam antibiotics in children: predictors for a positive oral challenge test
  1. Amanda L Wilkins1,2,3,
  2. Laure F Pittet4,5,6,
  3. Sophie Kyriakou2,7,
  4. Kimberly Walker2,
  5. Susan Donath3,8,
  6. Sharon Choo9,
  7. Noel Cranswick1,3,10,
  8. Amanda Gwee1,2,3,11
  1. 1Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
  2. 2Antimicrobials Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  3. 3Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  4. 4Infectious Diseases Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  5. 5Department of Infectious Diseases, The Royal Children's Hospital, Parkville, Victoria, Australia
  6. 6Infectious Diseases Unit, Department of Paediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
  7. 7Department of Microbiology, The Royal Children's Hospital, Parkville, Victoria, Australia
  8. 8Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  9. 9Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia
  10. 10Department of Clinical Pharmacology, Royal Children's Hospital, Parkville, Victoria, Australia
  11. 11Department of Infectious Diseases, The Royal Children's Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Amanda L Wilkins; amanda.wilkins{at}rch.org.au

Abstract

Objective Beta-lactam antibiotic allergies are reported in 5%–10% of children; however, up to 90% do not have any reaction at oral challenge test (OCT). This study aimed to determine the frequency and identify predictors of positive in-hospital graded beta-lactam OCTs in children with a beta-lactam antibiotic allergy label (AAL).

Design This is a retrospective study conducted over 7 years, including children aged 0–19 years who underwent a beta-lactam OCT. The OCT comprised an in-hospital graded challenge followed by a 5-day outpatient antibiotic course. Univariate and multivariate logistic regression analyses were performed to identify predictors of a positive in-hospital graded OCT.

Results Overall, 1259 beta-lactam OCTs were included: median age at time of OCT was 6.3 years (range 8.8 months to 19.2 years). Of these, 18 (1.4%) in-hospital graded OCTs were positive and 10 (0.8%) were equivocal, with only 4 children (0.3%) having an immediate, severe reaction to their in-hospital graded OCT. Factors associated with a positive in-hospital graded OCT on univariate analysis were: history of other drug allergy (OR 2.7, 95% CI 1.0 to 7.2; p 0.05), an index reaction which was severe (OR 2.9, 95% CI 1.1 to 7.6; p 0.035), immediate and severe (OR 5.85, 95% CI 1.7 to 20.0; p 0.005) or that required epinephrine (OR 9.65, 95% CI 1.7 to 53.6; p 0.01).

Conclusion Of the children referred with a beta-lactam AAL, only 1.4% had a positive in-hospital graded OCT. Risk factors for a positive in-hospital graded OCT were history of other drug allergy, an index reaction which was severe, immediate and severe or required epinephrine.

  • Allergy
  • Child Health
  • Paediatrics

Data availability statement

No data are available.

https://doi.org/10.1136/archdischild-2024-327036

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    Data availability statement

    No data are available.

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    Footnotes

    • Contributors ALW conceptualised and designed the study, acquired, analysed and interpreted the data for the work and drafted the initial manuscript. AG conceptualised and designed the study and assisted in drafting of the initial manuscript. SK, KW and SC all contributed substantially to data acquisition and reviewed and revised the manuscript critically for important intellectual content. LFP, SD and NC all contributed substantially to data analysis and interpretation of data for the work and reviewed and revised the manuscript critically for important intellectual content. Guarantors are ALW and AG.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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