[The challenge of delabeling antibiotic allergy in Colombian children: do parents trust the negative result of the drug provocation test with the implicated antibiotic?]

Abstract

Objective: To explore the factors associated with the use of the antibiotic implicated in an adverse reaction following a negative challenge test in pediatric patients in a clinical allergology service of a health institution in Medellin.

Methods: Observational cross-sectional study with analytical intent, in pediatric patients with a history of adverse reaction to an antibiotic, who underwent a provocation test and obtained a negative result. Sociodemographic and clinical data were obtained from medical records and parents or caregivers of patients who met the inclusion criteria were surveyed.

Results: Between January 2016 and December 2021, 571 antibiotic provocations were performed. Only 19.2% of patients received the implicated antibiotic or antibiotics of the same class after a negative challenge test, without experiencing adverse reactions related to the new use. However, 53% of those who did not receive the antibiotic, despite needing it, mainly because their parents or caregivers continued to report the allergy label. Additionally, 26.9% of parents or caregivers did not recall the negative test result, and 44.2% would refuse future administration of the antibiotic to their children, identifying failure to recall the negative challenge test result as a factor associated with this behavior.

Conclusions: Local strategies (providing individualized forms for parents and healthcare providers) should be designed to explain the meaning of a negative test result, as well as follow-up visits to verify adherence to recommendations, thus increasing the effectiveness of antibiotic allergy delabeling.