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<p>As many as 10% of families report a&#xa0;suspected allergy to an antibiotic, which cannot be confirmed by oral provocation testing in more than 90% of cases. These suspected allergies not only result in high costs due to the reliance on second line antibiotics but also promote the development of antibiotic resistance and often have a significantly less favorable side effect profile. For a targeted antibiotic treatment these assumed causal reactions must be rapidly allergologically reappraised. The consensus paper of the Society for Pediatric Allergology and Environmental Medicine, the German Society for Allergology and Clinical Immunology and the Medical Association of German Allergologists shows a way in which a delayed reaction to β-lactam antibiotics (BLA) can be conclusively and simply tested even in the outpatient setting. Mild maculopapular exanthema (MPE) can be the manifestation of a&#xa0;drug allergy or a&#xa0;nonspecific virus-induced rash. The occurrence of MPE is not associated with severe systemic reactions and never shows mucosal involvement. If uncomplicated MPE is diagnosed based on the patient history and risk factors are excluded, a&#xa0;3-day outpatient direct provocation regimen is recommended. The provocation can be applied in both childhood and adolescence. Prior skin testing and serological determination of specific IgE antibodies is not necessary. Far too often, the diagnosis of an antibiotic allergy is made after the onset of MPE in childhood. It must therefore be the responsibility of all physicians caring for children to promptly address this suspected diagnosis and revoke unnecessary allergy declarations. If, in exceptional cases, a&#xa0;genuine BLA allergy is proven, it is imperative that a&#xa0;suitable alternative preparation is provoked and released.</p>

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Delabeling bei V. a. verzögerte allergische Reaktion auf β‑Lactam-Antibiotika

  • 期刊论文

  • 发表日期：

    2025年10月20日

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  • Sophie Blatt,
  • Franziska Sattler,
  • Joachim List,
  • Sebastian Bode,
  • Irena Neustädter

摘要

As many as 10% of families report a suspected allergy to an antibiotic, which cannot be confirmed by oral provocation testing in more than 90% of cases. These suspected allergies not only result in high costs due to the reliance on second line antibiotics but also promote the development of antibiotic resistance and often have a significantly less favorable side effect profile. For a targeted antibiotic treatment these assumed causal reactions must be rapidly allergologically reappraised. The consensus paper of the Society for Pediatric Allergology and Environmental Medicine, the German Society for Allergology and Clinical Immunology and the Medical Association of German Allergologists shows a way in which a delayed reaction to β-lactam antibiotics (BLA) can be conclusively and simply tested even in the outpatient setting. Mild maculopapular exanthema (MPE) can be the manifestation of a drug allergy or a nonspecific virus-induced rash. The occurrence of MPE is not associated with severe systemic reactions and never shows mucosal involvement. If uncomplicated MPE is diagnosed based on the patient history and risk factors are excluded, a 3-day outpatient direct provocation regimen is recommended. The provocation can be applied in both childhood and adolescence. Prior skin testing and serological determination of specific IgE antibodies is not necessary. Far too often, the diagnosis of an antibiotic allergy is made after the onset of MPE in childhood. It must therefore be the responsibility of all physicians caring for children to promptly address this suspected diagnosis and revoke unnecessary allergy declarations. If, in exceptional cases, a genuine BLA allergy is proven, it is imperative that a suitable alternative preparation is provoked and released.