How to make right hypersensitivity test for antibiotics before injection for children?
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The routine skin test was not required before using β-lactam antibiotics in European and American countries; it was only carried out in China. In China, routine skin tests for cephalosporins had been canceled, but penicillin skin tests were still carried out at present for both adults and children. If penicillin was stopped for more than 72 h, the skin test should be repeated (Joerg et al., 2021; Jiang et al., 2023). In European and American countries, penicillin skin tests were only performed on patients with a history of allergies who needed penicillin (Forrest et al., 2001; Mirakian et al., 2015).
Since few studies have been performed on children, skin testing in the pediatric population has not been standardized. The guidelines, which can diagnose drug allergies in adults, were generally applied to pediatrics (Ibáñez et al., 2018). When the results of the skin test are positive, the patients are hypersensitive to the tested drug, and the administration is suspended (Kulhas Celik et al., 2020). In the past several years, the accuracy of skin tests has been questioned and discussed in some studies (Caubet et al., 2011; Ibáñez et al., 2018; Sousa-Pinto et al., 2021), and these studies highlighted that the diagnostic value of skin tests was not optimal in children. There are many diagnostic shortages in skin tests in children, such as low sensitivity and positive predictive value (PPV), especially for mild skin reactions (Arıkoğlu et al., 2022). A study indicated that skin tests could be false positives in 80% of cases, leading to the unnecessary avoidance of drugs (Ibáñez et al., 2018). A study indicated that higher concentrations of reagent, large injection volumes, and hidden additives or irritant effects could lead to false-positive results (Anterasian and Geng, 2018).
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