Cristina F. Rodrigues1, Ana Ribeiro1, Margarida Morais1, Ana Antunes1, Carmen Botelho2.
1Pediatrics Department, Hospital de Braga, Braga, Portugal,
2Immunoallergology Department, Hospital de Braga, Braga, Portugal.
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Abstract
Introduction: Unconfirmed amoxicillin allergy is an important public health problem due to the limitations it imposes on therapeutic choice. The aim of this study is to characterize the pediatric population suspected of amoxicillin allergy.
Methods: Observational, retrospective, descriptive and analytical study of the pediatric population with suspected amoxicillin allergy referred by general pediatrics to immunoallergology consultation between January 2018 and October 2019 in a tertiary care center.
Results: 224 patients (50% female) were studied. Most had atopy (n=159; 71%), however, the likelihood of drug allergy was not significantly higher in these children (p = 0.749). The median age of reaction was 22 months (minimum 4 months; maximum 17.7 years). The reaction was non-immediate in 99.6% and immediate in only one patient. The most frequent symptom was exanthema (96.4%); anaphylaxis occurred in one patient. 35.3% patients were previously exposed to the same antibiotic class. In ambulatory management, only one patient had positive specific IgE to ampicillin; all skin tests performed (n=25) were negative; four of the 138 amoxicillin oral provocation tests were positive; in 18 patients an alternative challenge was performed with cefuroxime and cefixime, which was negative. 41 patients did not undergo the oral provocation test. Allergy was confirmed in 5.4% patients (n=12).
Conclusions: Our results were consistent with international studies. Amoxicillin allergy, although rare in children, requires an accurate diagnosis, emphasizing the importance of approaching it in a specialized consultation to avoid severe adverse reactions, reduce the misdiagnosis of amoxicillin allergy patients and provide alternative treatment options.
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