The Investigation of Suspected Beta-Lactam Allergy in Children; Comparison of Contemporary Clinical Practice By International Specialists
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Ru-Xin M. Foong, Kirsty Logan, Michael Perkin, George Du Toit, MD FAAAAI
Rationale:  Beta-lactam allergy is commonly suspected in childhood with health implications for the individual and wider public. Diagnostic modalities include skin prick tests (SPT), specific-IgE tests, intradermal (ID) tests and drug provocation challenges (DPC). The aim of this study was to compare contemporary practice amongst International specialists to help inform standardized practice for the diagnosis of beta-lactam allergy. 

Methods:  Anonymized electronic questionnaire surveys were distributed over 3 months through International Allergy Societies for completion by Specialists who assess children. 

Results:  81 specialists, practicing in 16 countries completed the questionnaire. There is great variability between countries, in the selection of diagnostic tests. There is poor agreement on positive cut off values (IgE, SPT and ID) and practical techniques used to measure SPT or ID wheal diameters. DPC were considered the gold standard investigation with 93.8% of respondents undertaking DPC over the last 12 months; 64% of respondents considered DPC extremely useful for both exclusion and confirmation of beta-lactam allergy. However, there is a lack of consensus on when and how DPC should be performed. Overall, DPC are safe - only 2.6% of our respondents had patients who required intramuscular adrenaline and none had patients requiring admission to intensive care. 

Conclusions: There is a discrepancy between Allergy Specialists throughout the world in the selection and interpretation of tests used to diagnose and manage suspected beta-lactam allergy. The standardization of tests remains a priority in order to safely and effectively manage beta-lactam allergy.