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  • Luis Moral,
  • Francesca Mori
Luis Moral
Hospital General Universitari d'Alacant

Corresponding Author:[email protected]

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Francesca Mori
Azienda Ospedaliero Universitaria Meyer Pediatria medica
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A proper allergy work-up, based on the gold standard drug provocation test (DPT), usually rules out suspected drug hypersensitivity in children. These tests are generally open, given their high efficiency compared to double-blind placebo-controlled DPTs. Although their negative predictive value is excellent, no studies have calculated their positive predictive value, highly dependent on the prevalence of the disease. Most studies have found a rate of less than 5% to 10% of true beta-lactam hypersensitivity in children. Given this low prevalence (pre-test probability), a few false positive results can significantly reduce the estimated positive predictive value. False positives may arise from the nocebo effect during the test, including nocebo by proxy, or from observer bias, which depends on professional expertise and organizational circumstances. Some studies have found a high rate of tolerance on a second DPT in children who failed the first, but these results may be affected by the interval between the two tests, of a year or more in most cases, reflecting a loss of hypersensitivity over time. Taking into account the low rate of positive DPTs, with commonly mild reactions, we suggest confirming non-severe positive DPTs with a second provocation performed soon after the first, especially in the case of beta-lactam antibiotics, in order to improve the diagnostic accuracy, de-label more patients, and achieve a better estimation of true drug hypersensitivity prevalence.
10 Mar 2023Submitted to Pediatric Allergy and Immunology
10 Mar 2023Submission Checks Completed
10 Mar 2023Assigned to Editor
10 Mar 2023Review(s) Completed, Editorial Evaluation Pending
15 Mar 2023Reviewer(s) Assigned
11 Apr 2023Editorial Decision: Revise Major
20 Jun 20231st Revision Received
22 Jun 2023Submission Checks Completed
22 Jun 2023Assigned to Editor
22 Jun 2023Review(s) Completed, Editorial Evaluation Pending
24 Jun 2023Reviewer(s) Assigned
13 Jul 2023Editorial Decision: Accept