Introduction
Drug provocation test in children
Contraindications | • SCAR, Serum Sickness-Like Reactions, internal organ or system involvement. • Availability of alternative drugs, the drug will be probably not used in the future. • Suggestive clinical history, positive allergy tests. • Active disease such as uncontrolled asthma, urticaria, intercurrent infections, severe allergic rhinitis. Conditions that may affect treatment of allergic reactions, such as cardiovascular disease, treatment with β-blockers. |
Precautions | • The risk/benefit balance must be discussed with patient and caregivers in children with anaphylaxis. |
Indications | • Mild reactions. • Suggestive clinical history with negative or unavailable allergy tests. • Clinical history not suggestive and/or non-specific symptoms. • To exclude cross-reactivity with related drugs in subjects with known drug reaction. |
Betalactams
DPT in immediate reactions
DPT in delayed reactions
Betalactam provocation test protocol
Symptoms | Procedures |
---|---|
Immediate reactions with negative skin tests | Graded challenge 1/10 TD (1/100 TD or 1/1000 TD when risk is high, e.g. severe asthma) then 2/10 TD and 7/10 TD every 30 min 2 h observation after last dose |
Delayed reactions | Graded challenge as DPT for immediate reactions, or a full-dose challenge. The daily therapeutic dose is given at home for a minimum of 5 days up to 7 days. |
Positive skin tests Anaphylaxis | Desensitization |
Non-betalactam antibiotics
Sulphonamides
Macrolides
Glycopeptides
Aminoglycosides
Quinolones
Symptoms | Procedures |
---|---|
Mild urticaria or mild skin reactions | Full-dose challenge |
Mild/moderate urticaria or other skin reactions Negative skin tests | Graded challenge (1/100 TD or 1/1000 TD when risk is high, e.g. severe asthma) 1/10 TD 2/10 TD 7/10 TD 1 h observation after each dose |
Positive skin tests Anaphylaxis | Desensitization |
DPT to non-betalactam
Non-steroidal anti-inflammatory drugs (NSAIDs)
Diagnostic work-up
Drug | Dose (mg/kg) | Subsequent doses | Interval between doses (h) | Maximum dose (mg/kg) | Mean reaction time (h) | |
---|---|---|---|---|---|---|
Kidon MI, 2007 [91] | ASA | 2,5 | Same dose | 1 | 10 | 1–4 |
Ibuprofen | 2,5 | Same dose | 1 | 10 | 2–4 | |
Paracetamol | 5 | Same dose | 1 | 20 | 2–4 | |
Kidon M, 2018 [27] | 1/10–1/4 of the maximum dose | Incremental doses | 1 | - Paracetamol 15–20 mg/kg/dose, -Ibuprofen 10 mg/kg/dose, -ASA 15–20 mg/kg/dose | 2–4 Additional doses of the drug can be necessary on the following days at home |