Skin tests are important in children with β‐lactam hypersensitivity, but may be reduced in number

Abstract

There is no perfect agreement on how to perform an allergy work‐up in suspected beta‐lactam (BL) allergic children, since skin test (ST)‐induced pain is often a limitation. The aim of the study was to assess the possibility of reducing the number of ST in children when performing a complete allergy work‐up for BL hypersensitivity reactions. A retrospective analysis of all patients referring to the Allergy Unit of the University Hospital of Montpellier (France) with positive responses in immediate‐ and non‐immediate‐reading ST to a BL over a 16‐years period was performed, to determine the positive predictive value (PPV) of ST. All pediatric patients with a suspected BL hypersensitivity were skin tested with the suspected drug only, during the following 54 months. 319 patients reporting 328 BL reactions were included in the retrospective study. The PPV of ST for the reported drug was of 99.4%. Based on the results, the number of patients to include in the prospective study was estimated to be 101. In the prospective study, 229 children were included. We diagnosed a BL hypersensitivity in 12 children (5.2%): in 6 (50.0%) diagnosis was reached through ST (delayed reading for all) and in 6 through drug provocation test (DPT). STs with BL should therefore be performed as a screening test, before DPT, and testing only the suspected drug may be sufficient when dealing with children.