Efficacy and safety of five-day challenge for the evaluation of non-severe amoxicillin allergy in children

Publication date: Available online 7 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Roxane Labrosse, Louis Paradis, Jonathan Lacombe, Kathryn Samaan, François Graham, Jean Paradis, Philipps Bégin, Anne Des Roches
BackgroundPenicillin allergy is the most frequent drug allergy, among which aminopenicillins are reputed for causing delayed rashes in children, particularly in the context of viral infections. Despite a negative allergy evaluation, a significant proportion of individuals continue to avoid penicillin antibiotics for fear of an allergic reaction.ObjectivesThis study sought to evaluate the safety and efficacy of a five-day challenge to amoxicillin and the proportion of subsequent use of amoxicillin.MethodsPediatric patients with a history of a reaction to amoxicillin were prospectively recruited in the study. All patients were challenged, and those with negative immediate challenges underwent an ambulatory five-day challenge of amoxicillin to rule out nonimmediate reactions. Patients were called 2 years after their initial allergy evaluation to assess subsequent amoxicillin use and tolerance.ResultsOne hundred thirty children with a history of amoxicillin allergy underwent a graded drug provocation test (DPT) to amoxicillin. Three patients had a positive immediate challenge, three had a positive nonimmediate challenge, and two were equivocal. Of the 122 patients with a negative challenge, 114 (93.4%) were reached 2 years after their initial allergy evaluation: 75 had used antibiotics since, of which only 1 (1.3%) had refused to reuse amoxicillin because of fear of an allergic reaction. Finally, five-day DPT resulted in a 24.1% decrease in future penicillin avoidance compared to classical single-dose graded DPT performed over one day in a historical cohort (p<0.0001).ConclusionFive-day challenge is a safe and effective way to rule out nonimmediate amoxicillin allergy, and it ensures a better compliance with future penicillin use.