BackgroundAllergy to beta‐lactam antibiotics (BLA) is frequently suspected in children, but a drug provocation test (DPT) rules it out in over 90% of cases. Direct oral DPT (DODPT), without skin or other previous tests, is increasingly been used to delabel non‐immediate BLA reactions. This real‐world study aimed to assess the safety and effectiveness of DODPT in children with immediate and non‐immediate reactions to BLAs.MethodsAmbispective registry study in children (<15 years), attended between 2016 and 2023 for suspected BLA allergy in 15 hospitals in Spain that routinely perform DODPT.ResultsThe study included 2133 patients with generally mild reactions (anaphylaxis 0.7%). Drug provocation test with the implicated BLA was performed in 2014 patients (94.4%): 1854 underwent DODPT (86.9%, including 172 patients with immediate reactions). One hundred forty‐five (7.2%) had symptoms associated with DPT, although only four reactions were severe: two episodes of anaphylaxis and two of drug‐induced enterocolitis syndrome, which resolved rapidly with treatment. Of the 141 patients with mild reactions in the first DPT, a second DPT was considered in 87 and performed in 57, with 52 tolerating it without symptoms. Finally, BLA allergy was ruled out in 90.9% of the sample, confirmed in 3.4%, and remained unverified, usually due to loss to follow‐up, in 5.8%.ConclusionsDirect oral DPT is a safe, effective procedure even in immediate mild reactions to BLA. Many reactions observed in DPT are doubtful and require confirmation. Severe reactions are exceptional and amenable to treatment. Direct oral DPT can be considered for BLA allergy delabeling in pediatric primary care.

中文翻译：

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儿童立即和非立即 β-内酰胺过敏的直接口服激发：一项真实世界的多中心研究

背景经常怀疑儿童对 β-内酰胺抗生素 (BLA) 过敏，但药物激发试验 (DPT) 可以排除 90% 以上的病例。无需皮肤或其他先前测试的直接口服 DPT (DODPT) 越来越多地用于去除非立即 BLA 反应的标签。这项真实世界的研究旨在评估 DODPT 对于对 BLA 有立即和非立即反应的儿童的安全性和有效性。 方法 2016 年至 2023 年间，在 15 家医院就疑似 BLA 过敏的儿童（<15 岁）进行了双向登记研究。西班牙常规进行 DODPT。 结果 该研究纳入了 2133 名一般反应轻微的患者（过敏反应 0.7%）。对 2014 名患者（94.4%）进行了相关 BLA 的药物激发试验：1854 名患者接受了 DODPT（86.9%，包括 172 名立即反应的患者）。145 例 (7.2%) 出现与 DPT 相关的症状，但只有 4 例反应严重：两次过敏反应和两次药物诱发的小肠结肠炎综合征，这些症状通过治疗迅速消退。在第一次 DPT 中出现轻微反应的 141 名患者中，87 名患者考虑进行第二次 DPT，57 名患者进行了第二次 DPT，其中 52 名患者在没有症状的情况下耐受。最后，90.9% 的样本中 BLA 过敏被排除，3.4% 的样本得到证实，5.8% 的样本仍未得到证实，通常是由于失访所致。 结论 即使是立即发生轻微反应，直接口服 DPT 也是一种安全、有效的方法到 BLA。在 DPT 中观察到的许多反应都是可疑的，需要确认。严重反应属于特殊情况，可以接受治疗。在儿科初级保健中，可以考虑直接口服 DPT 以进行 BLA 过敏脱标签。