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Allergologie select, Volume 8 (2024) - 1st issue (206 - 211)

“Delabeling” by direct provocation testing in children and adolescents with a suspected history of a delayed reaction to β-lactam antibiotics. Consensus paper of Gesellschaft für pädiatrische Allergologie und Umweltmedizin (GPAU
Irena Neustädter1, Sophie Blatt1, Gerda Wurpts3, Heinrich Dickel4, Christian Walter5, Werner Aberer6, Sebastian Bode7, Timo Buhl8, Sunhild Gernert9, Susanne Harner10, Guido Heine11, Sebastian Kerzel10, Meike Köhler12, Lars Lange9, Joachim List13, Hans F. Merk2, Thomas Nüßlein14, Hagen Ott15, Franziska Sattler12, Antje Schuster16, Helen Straube17, Bettina Wedi18, Torsten Zuberbier19, Knut Brockow2
1 Pediatric and Adolescent Medicine, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, Nuremberg, 2 Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, 3 Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 4 Clinic for Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, 5 Practice for Pediatric and Adolescent Medicine, Allergology, Bad Homburg, Germany, 6 Department of Dermatology and Venereology, Medical University of Graz, Austria, 7 University Clinic for Children and Adolescents, Ulm, 8 Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, 9 Department of Pediatrics, St. Marien Hospital, GFO Clinics, Bonn, 1  0 Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University of Regensburg, Regensburg, 1  1 Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, 1  2 Asthma and Allergy Outpatient Clinic, Dr. von Hauner Children’s Hospital, LMU University Hospital, Munich, 1  3 University of Freiburg, Center for Pediatric and Adolescent Medicine, Freiburg, 1  4 Clinic for Pediatrics and Adolescent Medicine, Gemeinschaftsklinikum Mittelrhein, Koblenz, 1  5 Children’s and Youth Hospital Auf der Bult, Hanover, 1  6 Clinic for General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Düsseldorf, 1  7 Princess Margaret Children’s Hospital, Darmstadt, 1  8 Hannover Medical School, Clinic for Dermatology, Allergology and Venereology, Hanover, and 1  9 Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany

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DOI 10.5414/ALX02480E

Abstract

Background: Approximately 10% of European children are classified as allergic to drugs. In the majority of these children, no allergy to β-lactam antibiotics (BLA) can be found. In most cases, the exanthema is caused by the infection. Materials and methods: The objective of this paper is to describe the causes and consequences of a misdiagnosis of drug allergy. We propose a method for establishing a correct diagnosis in the case of a history of a delayed reaction during treatment with a BLA. For this purpose, a proposal was discussed via e-mail communication, and consensus was reached among the members of the drug allergy working groups of the participating medical societies. Results: The suspicion of a BLA allergy based on the medical history alone can have a negative impact on future antibiotic treatment. Exanthema associated with febrile infections not related to drug administration is a frequent finding in children. This makes it all the more important to be able to recommend a standardized procedure for clarification in children and adolescents with suspected hypersensitivity reactions. The medical history should be the basis on which to diagnose either a drug allergy or another possible differential diagnosis. A mild maculopapular exanthema (MPE) can be an expression of a drug allergy or a nonspecific viral exanthema. Uncomplicated MPE is not associated with significant systemic involvement, and there is no involvement of the mucous membranes or cutaneous blistering. Only a small number of children with uncomplicated MPE show positive skin tests and only ~ 7 – 16% of suspected BLA diagnoses can be confirmed by provocation tests. Thus, in children with uncomplicated MPE, drug provocation can be performed in an outpatient setting even without prior skin testing. This paper presents a 3-day outpatient direct provocation scheme for BLA delabeling in children with uncomplicated MPE. Conclusion: Many children and adolescents are unnecessarily denied treatment with BLA after an uncomplicated MPE while being treated with a BLA.

Author Details

Authors

Departments

  • 1 Pediatric and Adolescent Medicine, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, Nuremberg,
  • 2 Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich,
  • 3 Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen,
  • 4 Clinic for Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum,
  • 5 Practice for Pediatric and Adolescent Medicine, Allergology, Bad Homburg, Germany,
  • 6 Department of Dermatology and Venereology, Medical University of Graz, Austria,
  • 7 University Clinic for Children and Adolescents, Ulm,
  • 8 Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen,
  • 9 Department of Pediatrics, St. Marien Hospital, GFO Clinics, Bonn,
  • 1 
  • 0 Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University of Regensburg, Regensburg,
  • 1 
  • 1 Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel,
  • 1 
  • 2 Asthma and Allergy Outpatient Clinic, Dr. von Hauner Children’s Hospital, LMU University Hospital, Munich,
  • 1 
  • 3 University of Freiburg, Center for Pediatric and Adolescent Medicine, Freiburg,
  • 1 
  • 4 Clinic for Pediatrics and Adolescent Medicine, Gemeinschaftsklinikum Mittelrhein, Koblenz,
  • 1 
  • 5 Children’s and Youth Hospital Auf der Bult, Hanover,
  • 1 
  • 6 Clinic for General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Düsseldorf,
  • 1 
  • 7 Princess Margaret Children’s Hospital, Darmstadt,
  • 1 
  • 8 Hannover Medical School, Clinic for Dermatology, Allergology and Venereology, Hanover, and
  • 1 
  • 9 Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany

Address

Dr. med. Irena Neustädter, Pediatric and Adolescent Medicine, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, St.-Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
Email: [email protected]

Citation

Irena Neustädter, Sophie Blatt, Gerda Wurpts, Heinrich Dickel, Christian Walter, Werner Aberer, Sebastian Bode, Timo Buhl, Sunhild Gernert, Susanne Harner, Guido Heine, Sebastian Kerzel, Meike Köhler, Lars Lange, Joachim List, Hans F. Merk, Thomas Nüßlein, Hagen Ott, Franziska Sattler, Antje Schuster, Helen Straube, Bettina Wedi, Torsten Zuberbier, and Knut Brockow.“Delabeling” by direct provocation testing in children and adolescents with a suspected history of a delayed reaction to β-lactam antibiotics. Consensus paper of Gesellschaft für pädiatrische Allergologie und Umweltmedizin (GPAU. Allergologie Select. 2024; 8: 206-211. doi: 10.5414/ALX02480E.

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