Settembre 2013 - Volume XXXII - numero 7
Ricerca
Indirizzo per corrispondenza: e.novembre @meyer.it
Key words: Amoxicillin, Hypersensitivity, Children
Introduction - Adverse reactions to antibiotics, in particular to Amoxicillin, are frequently
reported by parents but the allergologic work-up confirms a true state of drug hypersensitivity
only in a small percentage of cases.
Objective - The aim of this study was to evaluate the utility of the skin tests methods and of
the specific serum IgE assays in the diagnosis of mild-moderate Amoxicillin hypersensitivity
reactions in children.
Materials and methods - 52 children (mean age 7.48 years) with history of mild-moderate
cutaneous adverse reactions following the ingestion of Amoxicillin syrup were examined;
the clinical manifestations of hypersensitivity were classified as immediate and non immediate
according to the timing of the reaction (within 1 hour and after 1 hour from the
last drug intake, respectively). Patients underwent skin tests (Skin Prick Test and Intradermal
Test), determination of total and specific serum IgE with an immunoassay method (UNICAP)
and with the epoxy-activated sepharose 6 B radioimmunoassay. All children underwent the
Oral Provocation Test (OPT) with Amoxicillin.
Results - 13/52 (25%) and 39/52 (75%) children had history of immediate and non immediate
reactions to Amoxicillin, respectively. The OPT resulted positive in 2 out of 13
(15.4%) and in 5 out of 39 (12.8%) of patients with history of immediate and non immediate
reactions, respectively. In 3 children with history of immediate reactions, Amoxicillin
specific serum IgE were detected by skin tests or in vitro tests and among them only one
child had a positive OPT. None of those 32 subjects with history of non immediate reactions,
who took the skin tests, had a positive response to immediate reading of the intradermal
test, whereas one child had a positive delayed intradermal response. 6 out of 39
children with history of non immediate reactions had specific serum IgE; it was shown by
the epoxy-activated method and among them 3 children had also a positive OPT. None of
the 39 subjects had positive results with the UNICAP. All OPT-positive subjects showed mild
skin reactions.
Conclusions - The present study highlights the weak utility of the in vivo and in vitro tests in
the diagnosis of non immediate Amoxicillin hypersensitivity reactions and on the other
hand, it emphasizes the importance and the relative safety of the OPT.
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