Oral challenge without skin testing in children with suspected non‐severe betalactam hypersensitivity

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Suspected allergy to betalactam is common in children. However, the risk of anaphylaxis and fatal anaphylaxis is low, estimated at 0.015%‐0.004% and 0.0015‐0.002% of treated patients, respectively (1, 2). Up to recently, a provocation challenge was recommended in children with a suspected betalactam hypersensitivity (BH) and negative skin tests. However, these tests are painful, time‐consuming, require skilled team, appropriate setting and their role has been debated. In a study of Caubet et al., both skin tests and oral challenge test (OCT) were performed in 88 children with a history of mild non‐immediate reactions with a betalactam antibiotic: 11 had an immediate positive intradermal test, but only 4 of them had a mild exanthema when challenged (3). In vitro and patch tests do not help for the diagnosis of these suspected drug reactions.

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