Graded PCs accurate and safe to confirm cutaneous related reactions to amoxicillin in children

Graded oral provocation challenge (PC) appears to be a safe and accurate test for confirming cutaneous-related reactions to amoxicillin in children, according a study published online in the journal JAMA Pediatrics (Apr. 4, 2016).

Investigators from the Research Institute of the McGill University Health Centre (RI-MUHC) in Montreal assessed 818 children who presented with a rash due to suspected amoxicillin allergy at the MCH-MUHC Allergy clinic from Mar. 2012 to Apr. 2015.

The authors noted that unlike previous studies all children had to undergo a graded PC.

Findings revealed that 94.1% of the children were tolerant to the graded PC for amoxicillin. Of the study’s participants, only 17 had an immediate positive reaction to amoxicillin, and only one within this group had a positive skin test. Data also found that 31 of the participants had non-immediate reactions developing more than one hour after challenge. The researchers also reported that all non–immediate reactions were mild and manifested mainly as skin eruptions.

“This is a game changer in the way physicians assess amoxicillin allergy in children given the fact that skin tests are still the recommended screening method in hospitals,” says the study’s lead author Dr. Moshe Ben-Shoshan, an allergist at the Montreal Children’s Hospital at the MUHC and assistant professor of Pediatrics at McGill.

“We showed that in children with a negative PC, amoxicillin can be safely used in the future, although under 10 per cent may develop mild cutaneous symptoms upon subsequent exposure," said Dr. Ben-Shoshan, who was quoted in a press release.

The authors concluded that future studies are required to assess factors associated with specific PC outcomes, and in particular researchers should investigate specific association with genetic markers to accurately determine future risk for antibiotic allergic reactions.

Above photo credit/source: McGill University Health Centre

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