Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

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Any child goes through multiple infectious diseases, usually viral and mild, along his childhood. Skin manifestations are a common symptom in many of those diseases, much more common than in adults. Antibiotics are commonly prescribed for infections in children. Thus, a significant number of children develop different types of skin rashes while being treated with an antibiotic. The vast majority of these children, concerning about 5% of general pediatric population according to studies based on questionnaire,1 are considered as allergic, mainly due to fear of a more severe reaction, without appropriate allergy testing. After a proper evaluation, allergy will be confirmed only in a small proportion of these children.3 Intradermal tests, usually performed in the allergy workup, are painful and difficult to interpret in children, especially in infants, and it may decrease the number of children with a suspicion of antibiotic allergy undertaking an allergy workup. However, the role of skin tests in the allergic evaluation of suspected non‐severe beta‐lactam hypersensitivity (BLH) has been recently highly debated.
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