RESUMEN
The specificity of pediatrician-diagnosed allergy reactions to penicillin, amoxicillin, and oral cephalosporins, which was based on contemporaneous examination of the patient, was evaluated by an elective skin testing program. Children and adolescents (n = 247) experiencing an adverse reaction to penicillin, amoxicillin, and/or an oral cephalosporin sufficient to lead to the recommendation to avoid further use were enrolled. Skin testing with penicillin G, commercial benzylpenicilloyl phosphate, penicillin minor determinate mixture, ampicillin, cefazolin, cefuroxime, and ceftriaxone was performed according to the suspected drug allergy followed by an oral challenge, repeat testing, and prospective follow-up if no reactions were observed. Overall, 84 (34.0%) of 247 patients had an IgE-type reaction on skin testing or oral challenge. Twenty-seven (32%) of 85 suspected penicillin reactions, 53 (34%) of 156 suspected amoxicillin reactions, and 13 (50%) of 26 suspected cephalosporin reactions were shown to be IgE mediated. Positive skin tests were observed in 20 patients with non-IgE-type clinical adverse reactions, including 15 patients with only a pruritic polymorphous rash. No reactions to oral challenge were severe after negative skin testing. One hundred sixty-three patients received multiple treatment courses with beta-lactam antibiotics after a negative skin testing procedure and three (1.8%) had adverse IgE reactions, all of which were mild. Physician-diagnosed allergic reactions to beta-lactam antibiotics based on patient examination at the time of the reaction is more accurate than patient history alone but still overestimates the rate of possible true allergy in 66% of patients. Elective penicillin, amoxicillin, and cephalosporin skin testing and oral challenge protocols are necessary to identify patients not at risk.
Asunto(s)
Alérgenos/inmunología , Amoxicilina/inmunología , Cefalosporinas/inmunología , Hipersensibilidad a las Drogas/diagnóstico , Penicilinas/inmunología , Pruebas Cutáneas , Adolescente , Antibacterianos/inmunología , Niño , Preescolar , Hipersensibilidad a las Drogas/etiología , Humanos , Inmunoglobulina E/inmunologíaRESUMEN
OBJECTIVE: To compare three traditional measures of compliance with antibiotic therapy (parent report diary, preregimen and postregimen bottle-weight difference, and urine bioassay for antibiotic activity), with a deuterium oxide tracer measure of compliance. METHODS: Clinical trial in which all four compliance measures were used for subjects participating in a comparison of the efficacy of azithromycin and penicillin in treating group A beta-hemolytic streptococcal infection. Subjects were 41 children, aged 3 to 15 years (average age, 7.9 years), in a suburban pediatric private practice, who had positive rapid streptococcal antigen test results. RESULTS: Of the 41 subjects, 20 children were randomly assigned to receive azithromycin and 21 to receive penicillin. Compliance was uniformly high by all four measures. Parent diaries indicated that all doses were administered. Urine bioassays were obtained for 40 subjects, and all showed antibiotic activity. Differences in bottle weights were obtained for 27 subjects and showed that 142% of the prescribed medication was missing from the bottles at the end of the regimen. The deuterium oxide measure was obtained for 40 subjects and showed that 107% of the prescribed azithromycin and 92% of the prescribed penicillin were ingested. The correlation coefficient between measured and expected deuterium enrichment was 0.89. There was no significant correlation between the bottle-weight measure and the deuterium oxide tracer. CONCLUSIONS: The bottle-weight measure overestimates compliance; the deuterium oxide tracer is feasible for use in an office setting and produces a high correlation between the expected urinary enrichment and the measured enrichment. Increased use of this quantitative and direct measure would improve the accuracy of compliance measurement in trials of pediatric liquid medications.
Asunto(s)
Deuterio , Embalaje de Medicamentos , Eritromicina/análogos & derivados , Padres , Cooperación del Paciente , Penicilina V/administración & dosificación , Penicilina V/orina , Agua , Adolescente , Azitromicina , Niño , Preescolar , Óxido de Deuterio , Embalaje de Medicamentos/estadística & datos numéricos , Eritromicina/administración & dosificación , Eritromicina/orina , Femenino , Humanos , Masculino , Faringitis/tratamiento farmacológico , Faringitis/epidemiología , Faringitis/orina , Análisis de Regresión , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/orina , Streptococcus pyogenes , Tonsilitis/tratamiento farmacológico , Tonsilitis/epidemiología , Tonsilitis/orinaRESUMEN
Milk was collected from 56 New York and 70 Venezuelan mothers participating in Rhesus rotavirus (RRV) pediatric vaccine trials. Plaque reduction neutralization antibody (PRNA) to RRV (VP7:3, VP4:RRV) and human P rotavirus (VP7:3, VP4:P) and epitope-blocking antibody to one RRV VP4 and VP7 epitope were determined. Controlling for postpartum age, more Venezuelan milk samples had detectable RRV and P PRNA, RRV VP4 epitope-blocking antibody (P less than or equal to .001), and higher RRV and P PRNA geometric mean titers (P = .01) than New York samples. Using a logistic regression model, both milk and infants' serum preimmunization RRV PRNA titers had a negative effect on seroconversion (P = .008 and .02, respectively). Only 25% (2/8) infants fed milk containing greater than or equal to 1:160 RRV PRNA seroconverted compared with 83% (5/6) fed milk containing less than 1:160 RRV PRNA (P = .1). Of milk samples containing greater than or equal to 1:160 RRV PRNA, seven (88%) of eight had greater than fourfold neutralizing activity against RRV versus P (P = .035), suggesting that VP4-specific milk antibodies may interfere with RRV seroconversion.
Asunto(s)
Anticuerpos Antivirales/análisis , Leche Humana/inmunología , Rotavirus/inmunología , Vacunas Virales/inmunología , Anticuerpos Antivirales/biosíntesis , Anticuerpos Antivirales/sangre , Antígenos Virales/inmunología , Unión Competitiva , Ensayo de Inmunoadsorción Enzimática , Epítopos/inmunología , Femenino , Humanos , Lactante , Recién Nacido , Pruebas de Neutralización , New York/epidemiología , Embarazo , Prevalencia , Infecciones por Rotavirus/epidemiología , Vacunación , Venezuela/epidemiologíaRESUMEN
We studied an immunogen consisting of oligosaccharides derived from Haemophilus influenzae type b capsular polysaccharide (PRP) coupled to CRM197, a nontoxic relative of diphtheria toxin. Subcutaneous injections were given to eight subjects at ages 2, 4, and 6 months, simultaneously with conventional diphtheria-tetanus-pertussis (DTP) vaccine. After the first immunization, total serum anti-PRP antibodies declined in all subjects, but increased in most after the second immunization and after the third in seven of seven subjects analyzed. In these seven infants, the geometric mean level at age 9 months (0.73 micrograms/ml) exceeded by at least 40 times the means of historical control groups given DTP only or DTP plus (uncoupled) PRP vaccine. An isotype-specific assay showed that IgM antibodies increased after the first immunization with the coupled vaccine in all eight infants. Against the background of declining maternal IgG antibody, elevations in IgG antibody were detected after the second or third immunization in six of the eight. These six at age 9 to 11 months were immunized with (uncoupled) PRP vaccine, and a "boost" in anti-PRP antibody, including an IgG component, was found.