ArticleThe Journal of allergy and clinical immunology2011
The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge.
Article in The Journal of allergy and clinical immunology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 85 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
85 citing papers in PubMed, 1 synthesis or guideline pooled it, 339 citations in OpenAlex.
- Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis.The Journal of allergy and clinical immunology · 2021Pooled it
- Trial
- Real-World Patterns of Delayed Cutaneous Adverse Reactions to Antimicrobial Therapy in Children: A Case Series and FAERS Analysis Across Age Groups.Antibiotics (Basel, Switzerland) · 2026Article
- Article
- Clinical and behavioral determinants in pediatric non-immediate drug hypersensitivity: Low confirmation but persistent avoidance.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
- Evaluation of pediatric patients with drug allergy confirmed by in vivo diagnostic tests.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
- Direct single dose mass delabelling of antibiotic allergy in pediatrics.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
- Lymphocyte transformation test in pediatric drug hypersensitivity: case series report from a tertiary care hospital.Frontiers in immunology · 2026Article
- Outpatient penicillin allergy de-labeling in primary care-whom to target.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Direct Single-Dose Drug-Provocation Test Is Safe for Delabelling Penicillin Low-Risk Reactions in Adults.Allergy · 2025Article
- Drug hypersensitivity reactions in children in clinical practice: A WAO Statement.The World Allergy Organization journal · 2025Review
- A Rash Decision: Implementing an EHR-Integrated Penicillin Allergy Delabeling Protocol without Adequate Clinician Support.Applied clinical informatics · 2025Article
- Success of amoxicillin challenges in the emergency department for children with low risk of serious reactions.Paediatrics & child health · 2025Article
- Resensitization-Should Repeat Testing Be Performed in Patients Undergoing Penicillin Allergy Evaluations? A Pro-Con Debate.The journal of allergy and clinical immunology. In practice · 2025Review
- Drug allergy.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2025Review
- Article
- Peritonsillar abscess in children: A retrospective analysis on surgical and antimicrobial approaches.PloS one · 2025Article
- Comparing pharmacists versus allergists in low-risk penicillin allergy delabelling: The Hong Kong Penicillin Allergy Pharmacist Initiative (HK-PAPI).The World Allergy Organization journal · 2024Article
- A call to address penicillin allergy labels in patients with hematopoietic stem cell transplants: How to avoid rash decisions.Transplant infectious disease : an official journal of the Transplantation Society · 2024Review
- Risk factors for drug hypersensitivity reactions in children.Italian journal of pediatrics · 2024Review
25 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelayed-onset urticarial or maculopapular rashes are frequently observed in children treated with β-lactams. Many are labeled "allergic" without reliable testing.
objectiveDetermine the etiology of these rashes by exploring both infectious and allergic causes.
methodsChildren presenting to the emergency department with delayed-onset urticarial or maculopapular rashes were enrolled. Acute and convalescent sera were obtained for viral screening along with a throat swab. Subjects underwent intradermal and patch skin testing for β-lactams 2 months after presentation. Anti-β-lactam blood allergy tests were also obtained. All subjects underwent an oral challenge test (OCT) with the culprit antibiotic.
resultsEighty-eight children were enrolled between 2006 and 2008. There were 11 (12.5%) positive intradermal and no positive patch tests. There were 2 (2.3%) positive blood allergy tests. There were 6 (6.8%) subjects with a positive OCT, 2 were intradermal-negative, and 4 were intradermal-positive. No OCT reactions were more severe than the index event. Most subjects had at least 1 positive viral study, 54 (65.9%) in the OCT negative group.
conclusionIn this situation, β-lactam allergy is clearly overdiagnosed because the skin rash is only rarely reproducible (6.8%) by a subsequent challenge. Viral infections may be an important factor in many of these rashes. OCTs were positive in a minority of intradermal skin test-positive subjects. Patch testing and blood allergy testing provided no useful information. OCTs should be considered in all children who develop a delayed-onset urticarial or maculopapular rash during treatment with a β-lactam.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.