Individual research recommendation details

Recommendation ID

CG183/4

Question

Oral antibiotic challenge for diagnosing antibiotic allergy in children:- In children who have a suspected allergy to an antibiotic, is it clinically and cost effective to proceed directly (without prior skin or intradermal tests) to a diagnostic oral antibiotic challenge rather than referring them to specialist drug allergy services?

Any explanatory notes
(if applicable)

Antibiotics are an important class of drug and one of the most common groups of drugs prescribed to children. Many childhood illnesses are associated with skin rashes, and it can be clinically difficult in the acute setting to be certain if an atypical rash is caused by the underlying illness, the antibiotic, or both. Adverse drug reactions to antibiotics are common and frequently result in a child being diagnosed with 'drug allergy', a diagnosis which generally remains for life. Current clinical experience suggests that most patients in a community setting who are believed to be allergic to an oral antibiotic (approximately 3% for children, 10–20% for adults) will be challenge 'negative' – that is, they are able to tolerate the oral antibiotic on the day of the challenge and on subsequent days. While patients who are correctly diagnosed with an allergy are kept safe through avoidance, there are health and cost implications for patients who are incorrectly diagnosed with an antibiotic allergy.
The evidence review for this clinical guideline found no evidence to support the reliability of allergy testing (skin, intradermal or IgE determination) for the diagnosis of antibiotic allergy in children. In addition, these tests are painful and restricted to only a few specialist centres in the UK. The result is that only a small fraction of children in the UK with a diagnosis of antibiotic allergy ever undergo investigations to confirm or exclude this diagnostic 'label'. It would therefore be beneficial to prospectively investigate the use of the oral supervised challenge in a safe clinical setting without prior allergy testing. This novel diagnostic approach could be compared with an intervention of 'antibiotic avoidance'.
If the oral antibiotic challenge is found to be safe, acceptable and cost effective, it could be rolled out across all centres that offer paediatric allergy services. This would substantially reduce the number of children who receive a lifelong label of antibiotic allergy.

Source guidance details

Comes from guidance

Drug allergy: diagnosis and management

Number

CG183

Date issued

September 2014

Other details