Allergy to β-lactam antibiotics—Comparing pediatric and adult patients

Allergy to β-lactam antibiotics—Comparing pediatric and adult patients

S336 Abstracts J ALLERGY CLIN IMMUNOL FEBRUARY 2003 1071 Characteristics of a Groupof Immediate Reactionsto Beta1073 Allergy i n lto Beta-Lactam s r...

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S336 Abstracts


1071 Characteristics of a Groupof Immediate Reactionsto Beta1073 Allergy i n lto Beta-Lactam s r a e Antb ilo i tcis lactams Selected During2000-2002 M. Padial L, R. Blanco I, M. Belver t , M. Torres 2, C. Mayorga 2, M. Blancal; 1Allergy Service, University Hospital La Paz, Madrid, SPAIN, 2Research Unit for Allergic Diseases, Carlos Haya Hospital, Malaga, SPAIN. RATIONALE: Side chain specific determinants are now used for evaluating subjects with immediate allergic reactions OAR), Changes in skin test reactivity patterns with different haptens have been reported. This study considered the population evaluated during 2000-2002 for assessing the response pattern to Betalactam determinants. METHODS: Sixty one patients were studied with IAR history to penicillins using skin tests with BPO/MDM, Amoxicillin (AX), Ampicillin (AMP), and lgE specific antibodies determination to BPO, AX and AMP (CAP-FEIA). Controlled administration was pedormed with negative in vitro and in vivo tests. RESULTS: Sixty cases were included (54% developed anaphylaxis, 28% urticaria and/or angioedema), According to clinical history, AX was involved in 77% of the cases. Skin test positivity to at least one determinant appeared in 67% of the cases. From all skin tests 64.8% were positive to AX determinants. One subject developed systemic symptoms after skin testing. The diagnosis was established by in vitro test in 4.91% of the patients and by controlled administration in 13%. In 11 patients with severe reactions controlled administration was not performed and the diagnosis was based on the clinical history consistency. From the total group, 54% of patients evaluated in the first four months after the reaction presented positive skin tests and/or CAP. CONCLUSIONS: The predominant role of AX shows a tendency to be higher than in previous studies, The systemic effects after skin testing were low (1.6%) and the in vitro test value was lower than previously reported. Further research should compare existing studies with similar populations.

Funding: FIS '1072

aAuergy sn etinPta t~ ~'Lactam d A Antibi~176 d u




L. M. Borrego, P. Leiria-Pinto, C. Braga, T. Almeida, A. Gaspar, E. Pargana, J. Rosado-Pinto; lmmunoallergy Department, Dona Esteffinia Hospital, Lisbon, PORTUGAL. BACKGROUND: Adverse reactions to I]-lactam antibiotics are frequent. Skin tests with major (PPL) and minor (MDM) penicillin determinants (Allergopen| were used for penicillin allergy diagnosis. Anaphylactic reactions have been associated to minor determinants of penicillin. The aim of this study was to compare the prevalence of allergy to J~-lactam antibiotics in children and adults, as well as to assess the Allergopen| efficiency and safety. METHODS: We included 167 patients referring an adverse reaction to [3lactams, age range 8 months to 62 years old, 70% <_15 years and 30% >15 years. To all patients we performed skin tests (prick and intraderrnal) with PPL, MDM and soluble form of the suspect antibiotic. Oral challenge (OC) were made if negative skin tests. Informed consent was obtained. RESULTS: Allergopen| was positive in 16,8%; 13,7% _15 years and 24% >15 years, lntradermal test with suspect antibiotic was positive in one patient with negative Allergopen| Test sensitivity-90,3%, negative predictive value-97,8% and efficiency-98,2%. During skin tests occurred 3 (6%) anaphylactic reactions (PPL-2 and MDM-I), among patients >15 years (n=50). None occurred in younger patients (p<0.05). OC were positive in 1,4% of negative Allergopen| patients (mild and non-immediate reactions). CONCLUSIONS: We found a higher prevalence of allergy to [3-/actams in adults comparing with children although without statistical significance. Anaphylactic reactions only occurred in adults with statistical significance comparing to children. The occurrence of anaphylactic reactions to PPL may lead us to the need of using dilutions of PPL, which is not the common procedure. This results stress the need to develop safer diagnostic procedures.

Funding: Self-funded

Children in Southern

J. Hershkovichh2, L. Kirjner3, H. Smit4, N. Medan 5, R. Gorodischer3.6; 1Pediatric Allergy Clinic, Soroka Medical Center, Beer-Sheva, ISRAEL, 2Faculty of Health Sciences, Ben-Gurion University of the Negev, BeerSheva, ISRAEL, 3pediatric Department "A" Soroka Medical Center, BeerSheva, ISRAEL, 4Farmacology, Soroka Medical Center, Beer-Sheva, ISRAEL, 5Soroka Medical Center, Beer-Sheva, ISRAEL, 6Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, ISRAEL. RATIONALE: Assessment of (1) reported (RBLA) versus real prevalence of beta-lactam allergy, and (2) ethnic differences in RBLA, in Southern Israel children. METHODS: Medical records in primary clinics of Jewish (N=I 1,069) and Bedouin (N=15,586) children were reviewed. Children suspected to be allergic to a beta-lactam underwent skin testing. Negative skin tests were followed by oral challenge with the relevant antibiotic. Reagents used: benzyl-penicilloyl-polylysine, benzylpenicillin, minor determinant mixtures of penicillin, ampicillin, cloxacillin and cephalosporins, normal saline and histamine. Possibility of re-sensitization caused by the first set of tests was studied by repeated skin and challenge tests 1-5 months later. RESULTS: (1) Medical records review: 344 children (I.3%) had diagnosis of allergy to one or more beta-lactams (2.1% Jewish and 0.8% Bedouin p < 0.001 ). Boys/girls ratio was 1.7 (p<0.01 ). Beta lactams implicated were amoxycillin (41.9%), penicillin (28.8%), cephalosporins (21.5%), "Augmentin" (14.2%), and more than one (9.5%). Allergic reactions reported were rash (47.1%), urticaria (20.3%), angioedema (3.5%), other (8.1%) and not-specified (29%). (2) Allergy tests: 99 children with RBLA were tested. 65 were diagnosed as non-allergic to beta-lactams, and 7 allergic. All allergic reactions were mild and subsided without treatment. 27 children with a negative first set of tests have not yet concluded the second set. CONCLUSIONS: Considerable ethnic differences in RBLA were documented. Boys/girls ratio was greater than reported in the literature, Skin testing (to major and minor determinants) complemented by oral challenge, is sale and highly predictive to assess a type I reaction to these drugs.

Funding: Self-funded

1074 Characterization of Baltimore City School Children with Asthma Evaluatedon the Breathmobile C. D, Schwindt, C. Blaisdell, M. Ramagopal, S. Irving, M. Foster, K. Mudd, M. Bollinger; Pediatrics, University of Maryland Medical System, Baltimore, MD. RATIONALE: This study evaluated baseline asthma severity levels and atopy of underserved Baltimore school children referred to the University of Maryland Breathmobile| The prevalence of asthma in Baltimore City is higher than the national average, with some schools reporting prevalence rates as high as 10-20%. The Breathmobile| is a mobile asthma clinic that provides specialty services to asthmatic children at their schools. The severity levels and atopy of these students have never been reported. METHODS: Since operations began in March 2002, the Breathmobile| has visited 14 Baltimore Public Schools and assessed over 135 students. Chart review included analysis of the medical history, physical exam, spirometry testing, skin testing (environmental allergens) and physician diagnosis of asthma according to NHLBI guidelines. RESULTS: Demographic analysis of 135 subjects demonstrated the population is between the ages of 4-17 years. Assessment of subject asthma severity levels demonstrated 39% with Mild Intermittent, 43% Mild Persistent, 8% Moderate Persistent, 1% Severe Persistent, 1% of ExercisedInduced-Asthma (EIA) and 4% had no asthma identified. Of these subjects, 73 (54%) were skin tested. 79% were atopic to at least I aeroallergen. Atopy was found in 69% with Mild Intermittent, 83% Mild Persistent, 100% Moderate Persistent, 100% Severe Persistent, and 50% with EIA. In non-asthmatics, 73% were atopic.