Allergy to betalactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests.

To cite this article: Ponvert C, Perrin Y, Bados-Albiero A, Le Bourgeois M, Karila C, Delacourt C, Scheinmann P, De Blic J. Allergy to betalactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests. Pediatr Allergy Immunol 2011; 22: 411-418. ABSTRACT: Studies based on skin and challenge tests have shown that 12-60% of children with suspected betalactam hypersensitivity were allergic to betalactams. Responses in skin and challenge tests were studied in 1865 children with suspected betalactam allergy (i) to confirm or rule out the suspected diagnosis; (ii) to evaluate diagnostic value of immediate and non-immediate responses in skin and challenge tests; (iii) to determine frequency of betalactam allergy in those children, and (iv) to determine potential risk factors for betalactam allergy. The work-up was completed in 1431 children, of whom 227 (15.9%) were diagnosed allergic to betalactams. Betalactam hypersensitivity was diagnosed in 50 of the 162 (30.9%) children reporting immediate reactions and in 177 of the 1087 (16.7%) children reporting non-immediate reactions (p < 0.001). The likelihood of betalactam hypersensitivity was also significantly higher in children reporting anaphylaxis, serum sickness-like reactions, and (potentially) severe skin reactions such as acute generalized exanthematic pustulosis, Stevens-Johnson syndrome, and drug reaction with systemic symptoms than in other children (p < 0.001). Skin tests diagnosed 86% of immediate and 31.6% of non-immediate sensitizations. Cross-reactivity and/or cosensitization among betalactams was diagnosed in 76% and 14.7% of the children with immediate and non-immediate hypersensitivity, respectively. The number of children diagnosed allergic to betalactams decreased with time between the reaction and the work-up, probably because the majority of children with severe and worrying reactions were referred for allergological work-up more promptly than the other children. Sex, age, and atopy were not risk factors for betalactam hypersensitivity. In conclusion, we confirm in numerous children that (i) only a few children with suspected betalactam hypersensitivity are allergic to betalactams; (ii) the likelihood of betalactam allergy increases with earliness and/or severity of the reactions; (iii) although non-immediate-reading skin tests (intradermal and patch tests) may diagnose non-immediate sensitizations in children with non-immediate reactions to betalactams (maculopapular rashes and potentially severe skin reactions especially), the diagnostic value of non-immediate-reading skin tests is far lower than the diagnostic value of immediate-reading skin tests, most non-immediate sensitizations to betalactams being diagnosed by means of challenge tests; (iv) cross-reactivity and/or cosensitizations among betalactams are much more frequent in children reporting immediate and/or anaphylactic reactions than in the other children; (v) age, sex and personal atopy are not significant risk factors for betalactam hypersensitivity; and (vi) the number of children with diagnosed allergy to betalactams (of the immediate-type hypersensitivity especially) decreases with time between the reaction and allergological work-up. Finally, based on our experience, we also propose a practical diagnostic approach in children with suspected betalactam hypersensitivity.

Missouri River Floods After Action Report, December 20, 2011

In May 2011, very heavy rains combined with above average snowpack caused reservoirs throughout the Upper Missouri River basin to swell. The river carried more water in May and June than it does in an average year. The six Iowa counties bordering the river—Fremont, Harrison, Mills, Monona, Pottawattamie and Woodbury—suffered from major flooding which persisted throughout the spring and summer. On June 2, Governor Terry Branstad issued a Proclamation of Disaster Emergency for the six impacted counties. The Iowa Homeland Security and Emergency Management Division (HSEMD) activated the State Emergency Operations Center (SEOC) on June 10 to coordinate State, Federal, private sector, and voluntary agency preparedness and response activities in the affected area. The severity and duration of the flooding presented operational challenges for the SEOC and its partner agencies, which were further complicated by severe weather. The flooding forced the SEOC to conduct simultaneous response and recovery operations for an usually long period of time. The Missouri River floods caused major economic losses in Western Iowa. As a result of these economic losses, President Barack Obama issued a Major Disaster Declaration (FEMA-1998-DR) which made six counties eligible for Federal Public Assistance. The disaster declaration was subsequently amended on October 18, making five counties eligible for Federal Individual Assistance.

Farm Families Alive and Well, September 2014, Vol. 20, no. 4

News from Iowa’s Center for Agricultural Safety and Health (I-CASH)

Iowa Agri-News, September 11, 2014, Vol. 14, no. 20

Crop and livestock summaries for the state of Iowa, produced by the Iowa Department of Agriculture. Previously Agri-News

Iowa Crop Progress & Condition, October 20, 2014

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October. Formally titled: Iowa Crop and Weather Report

Oeuvres complètes de J. Michelet. T. 20, 4

Comprend : Oeuvres choisies de Vico

Barcellona: osservazioni sulla letteratura riguardante i modelli di indirizzo dell'urbanistica negli ultimi 20 anni

This article proposes a synthetic examination of the modifications that can be found in the official City of Barcelona publications regarding urban transformations in the city in the last 20 years. The main objective is to understand the relationship between urban planning projects and the books published by the city’s various administrations, as well as correspondent urban and social policies. An attempt is made to analyse what has been the programmatic development in light of similar parameters of comparison based on a hypothesis in which the publications, like the projects, have a double role of synthesis with respect to the past and the construction of a collective imaginary on the city regarding the future

Water Summary Update, March 7, 2013, No. 20

A snapshot of water resource trends prepared by the Iowa DNR in collaboration with the Iowa Department of Agriculture and Land Stewardship, the U.S. Geological Survey, and The Iowa Homeland Security and Emergency Management Department.

2001-2002 University of Northern Iowa Comprehensive Annual Financial Report, December 20, 2002

Comprehensive Annual Financial Report For University of Northern Iowa.

Quick Reads, November 20, 2014

IDPH Quick Reads is an electronic newsletter produced by the Director’s Office at the Iowa Department of Public Health. IDPH Quick Reads are published every three to four weeks.

Associacionisme juvenil a l'Alt Empordà: 20 anys de joves compromesos

L’associacionisme juvenil es manifesta com un dels contextos socials per excel•lència, on el jove pot assolir un rol social, amb capacitat crítica i protagonisme en la presa de decisions. Uns espais que són necessaris per anar configurant la experiència cívica dels joves i que atresoren un potencial molt gran per a la democratització i la construcció de societats més fortes i cohesionades. Analitzar l'evolució de l'associacionisme juvenil al llarg dels darrers 20 anys i el perfil dels joves que hi han pres part durant aquest període, juntament amb el de conèixer el valor i el conjunt d’aportacions que aquest genera pels associats, i de quina forma incideixen aquestes en el seu itinerari personal i professional, configuren els interessos del present treball, contextualitzat a l’Alt Empordà i basat en bona mesura, en l’experiència vital de joves compromesos en el moviment associatiu de la comarca

Precordial abscess inducing chest pain 20 years after surgical repair of a pentalogy of fallot.

A 25-year-old male asylum-seeker presented with chest pain, exertional dyspnea, and orthopnea 20 years after the surgical repair of a pentalogy of Fallot. An extracardiac mass compressing the right ventricle was subsequently detected and surgical decompression was performed to relieve the resulting right intraventricular hypertension. At operation, the mass proved to be a coagulase-negative, staphylococcal abscess. In addition, the removal of the mass unmasked a previously nonrecognized pulmonary outflow stenosis that required balloon dilatation and beta-blocker therapy. While infections are known to occur after sternotomy, the formation of an abscess in the anterior mediastinum several years after the intervention appears to be exceptional; this diagnosis came to mind only after the more common complications had been considered, e.g., pseudoaneurysm or pericardial hematoma. To our knowledge, this is the first report of an abscess in the anterior mediastinum that had probably formed over many years following a sternotomy, compressed the right ventricle and masked a pulmonary stenosis.