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β-lactam antibiotics are the most commonly prescribed pediatric medication worldwide and are frequently implicated in urticarial or maculopapular reactions that occur more than 1 hour after ingestion. These delayed reactions are likely T-cell mediated.
In a prospective observational study, researchers examined the cause of nonimmediate urticarial or maculopapular reactions that occurred up to 72 hours after β-lactam ingestion in 88 children (age range, 0–16 years) who presented to one emergency department in Switzerland. All patients underwent intradermal and patch skin testing, specific IgE determination (sIgE), viral serology, and oral challenge tests (OCTs).
Only six children had positive OCT reactions; all reactions were mild and similar …