Abstract
Beta-lactam allergy is commonly diagnosed in paediatric patients, but over 90% of individuals reporting this allergy are able to tolerate the medications prescribed after evaluation by an allergist. Beta-lactam allergy labels are associated with negative clinical and administrative outcomes, including use of less desirable alternative antibiotics, longer hospitalizations, increasing antibiotic-resistant infections, and greater medical costs. Also, children with true IgE-mediated allergy to penicillin medications are often advised to avoid all beta-lactam antibiotics, including cephalosporins, which is likely unnecessary in greater than 97% of those reporting penicillin allergies. Most patients can be safely treated with penicillin or amoxicillin if they do not have a history compatible with IgE-mediated or systemic, delayed reactions such as Stevens-Johnson syndrome (SJS), serum sickness-like reactions, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, or acute generalized exanthematous pustulosis (AGEP). Guidance is provided on how to stratify risk of beta-lactam allergy, and on test dosing and monitoring in the outpatient setting for patients deemed low risk. Guidance for patients at higher risk of beta-lactam allergy includes criteria for appropriate referral to allergists and the use of alternative antimicrobials, such as cephalosporins, while awaiting specialist assessment.
Keywords: Beta-lactam, Challenge, Drug allergy, Penicillin
EXECUTIVE COMMITTEE OF THE CANADIAN PAEDIATRIC SOCIETY ALLERGY SECTION
Executive members: Elissa M. Abrams MD (President), Edmond S. Chan MD (Secretary-Treasurer)
Principal authors: Tiffany Wong MD, Adelle Atkinson MD, Geert t’Jong MD, Michael J. Rieder MD, Edmond S. Chan MD, Elissa M. Abrams MD
Received: October 5 2018Accepted: March 19, 2019
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