Original Article
Asthma, Family History of Drug Allergy, and Age Predict Amoxicillin Allergy in Children

https://doi.org/10.1016/j.jaip.2017.11.015Get rights and content

Background

Suspected adverse reactions to amoxicillin are common, but there are no known factors that can predict amoxicillin allergy in children. In addition, methods used for the diagnosis of amoxicillin allergy are not standardized and their role in diagnosis is not clear.

Objective

To identify predictive factors and to assess the role of skin test in the diagnosis of amoxicillin allergy in children.

Methods

Children with a history of immediate (excluding anaphylaxis) or nonimmediate reactions to amoxicillin were tested by skin prick test, followed by oral graded challenge with amoxicillin. Clinical characteristics of the reaction before and after the challenge were recorded, and data of personal and relatives' drug allergies and atopy were collected for statistical analysis.

Results

Skin prick tests followed by an oral graded challenge with amoxicillin were performed on 133 children. The skin test result was not of clinical value because it was negative in all children. Three children (2%) had an immediate reaction and 7 children (5%) had a nonimmediate reaction. Asthma (odds ratio [OR], 0.12; 95% CI, 0.017-0.869; P = .03), family history of drug allergy (OR, 0.12; 95% CI, 0.026-0.613; P = .01), older age at reaction (OR, 0.837; 95% CI, 0.699-1; P = .05), and angioedema (OR, 0.22; 95% CI, 0.043-1.12; marginally significant at P = .069) were associated with reduced chance to pass the oral challenge.

Conclusions

Skin prick test did not contribute to the diagnosis of amoxicillin allergy. The presence of asthma, family history of drug allergy, and older age at reaction can be used as predictive factors for true amoxicillin allergy in children.

Section snippets

Study cohort

The study was performed at the Wolfson Medical Center, Holon, Israel. Included in the study were children who had been referred to the Allergy unit in our center from January 1, 2013, to December 31, 2015, with a suspected allergic reaction to amoxicillin or amoxicillin-clavulanate antibiotic. Patients with a history of a severe cutaneous adverse reaction (eg, Stevens-Johnson syndrome/toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized

Results

Characteristics of study participants and clinical reactions are described in Table I. In summary, most of the reactions presented with generalized rash and were delayed (appeared more than 1 hour after the drug administration). None of the participants had cardiovascular involvement. A significant fraction of the patients had a personal or family history of atopy (asthma, food allergy, allergic rhinitis, or atopic dermatitis) and family history of drug allergy.

The results of SPT and OGC are

Discussion

It has been shown previously that amoxicillin allergy is overdiagnosed in children and can only rarely be reproduced by OGC.3 In most cases, these so-called allergic reactions are mild and limited to the skin and related to concomitant viral infections. In contrast to other allergic phenomena, such as asthma and allergic rhinitis or eczema and food allergy, there is no clear association between atopy and drug allergy. There have been a few attempts in the past to find risk factors for drug

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    Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

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