The simplified pharmacostimulation test evaluates non-immediate amoxicillin reactions in children

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A single therapeutic dose given on the first day of a pharmacological stimulation test may be safe in diagnosing mild non-immediate reactions to amoxicillin-clavulanic acid, according to a study published in Children’s allergy and immunity.

This single dose will save time because patients will spend less time in the hospital, Julia LicioliMD, From the Allergy Unit in the Department of Pediatrics at Mayer University Children’s Hospital in Florence, Italy, and colleagues.

Data are from Liccioli G, et al. Pediatric Allergy Immunol. 2022; doi: 10.1111/pi.139809.

The study included 354 patients (50.6% boys; mean age at reaction, 4.8 years; standard deviation, ± 3.7 years) with a history of mild non-immediate reactions to amoxicillin or amoxicillin-clavulanic acid who underwent a drug stimulation test (DPT) At Mayer University Children’s Hospital between January 1, 2016 and August 31, 2021.

According to the researchers, 9.6% of children had a suspected reaction to amoxicillin, and 90.4% had a suspected reaction to amoxicillin-clavulanic acid. 60% of them also tolerated the drug in the years prior to the indicator reaction.

Among the 354 DPTs (6.5%), there were 23 positive results, with 2 positive for amoxicillin and 21 for amoxicillin-clavulanic acid. Eleven of these 23 participants had reactions within the first or second day of the DTP vaccine in the hospital within 2 to 8 hours of receiving the last dose, with one participant reacting approximately 30 minutes after the first dose.

Also, 11 of these 23 participants reacted at home between 24 and 48 hours after the last dose on the fifth day of treatment.

Only one participant responded with urticaria 30 minutes after first taking one tenth of the therapeutic dose.

The researchers further noted that 14 of these 23 participants exhibited the same cutaneous manifestations described in their history during DPT. The other participants developed rashes similar to those reported during their first visit.

These reactions were all mild, the researchers wrote, with seven requiring antihistamine treatment and 16 improving without any treatment. No other associated clinical manifestations or systemic involvement were observed.

Finally, children with positive DPTs were evaluated for a second time, with 16 of 23 lymphocyte transformation tests taking and six receiving a positive result. One participant underwent a patch test, and the result was negative.

Only one of 354 participants had a positive intradermal test. The researchers found that DPT with the culprit drug confirmed this finding, confirming the poor utility of skin tests for non-immediate interactions with amoxicillin or amoxicillin-clavulanic acid.

Skipping the intradermal test and taking the oral DPT test directly is safe, according to the researchers, even when the duration of the DPT test is not reported. But since most cases of positive DPTs occurred among patients with a history of reactions within 6 hours of the last drug administration, the researchers added, the clinical history must be properly collected at the start of testing.

Doctors also need to pay more attention to patients with a history of reactions that occur up to 6 hours after the last drug dose, the researchers continued, because their results cannot rule out overlap between immediate and non-immediate reactions. The researchers write that a graded DPT protocol would be appropriate in these cases.

Prolonged DPTs increase the diagnostic value of non-immediate reactions, according to the researchers, but they also carry risks of increased antibiotic resistance, which is why the current literature recommends a more personalized approach to testing.

Specifically, researchers recommend a 1-day direct DPT with a full dose for patients with a clear history of latency and symptom severity and a graded DPT for those who react between 1 and 6 hours after the last drug dose.

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