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Background: Mild non‐immediate reactions (NIR) to beta‐lactams (βLs) are the most common manifestation of adverse drug reactions in children, and the drug provocation test (DPT) remains the gold standard for diagnosis. However, there are still controversies about the protocol that should be used, especially regarding the administration of doses and the DPT length. Objective: This study aimed to evaluate a pediatric population with a history of mild NIR to amoxicillin (AMX) or to amoxicillin‐clavulanic acid (AMX/CL) who underwent a diagnostic workup including a DPT with the culprit drug, to understand if a graded DPT or, instead, a single full dose could be the most appropriate way of administration in clinical practice. Methods: The data of children were retrospectively analyzed for a 5‐year period, with demographic and clinical characteristics collected. We reported the allergy workup and the results of the DPT performed with the administration of incremental doses and a prolonged DPT at home for a total of 5 days. Results: Three hundred fifty‐four patients were included. Overall, 23/354 (6.5%) DPTs were positive: 11/23 patients showed a reaction after 2–8 h after the last dose on the 1st or 2nd day (1 reacted 30 min after the last dose), 1/23 reacted with urticaria 30 min after the first dose, 11/23 reacted at home on the 5th day of the DPT. Conclusion: This paper indirectly suggests that a single therapeutic dose administered on the 1st day of a DPT could be safe in the diagnostic workup of mild NIR to AMX/CL. Moreover, this could be less time‐consuming as patients would spend less time in the hospital, also considering the public health restrictions imposed during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: Mepolizumab proved to be an efficacious treatment for eosinophilic granulomatosis with polyangiitis (EGPA) at a dose of 300 mg every 4 weeks in the randomized, controlled MIRRA trial. In a few recently reported studies, successful real‐life experiences with the approved dose for treating severe eosinophilic asthma (100 mg every 4 weeks) were observed. We undertook this study to assess the effectiveness and safety of mepolizumab 100 mg every 4 weeks and 300 mg every 4 weeks in a large European EGPA cohort. Methods: We included all patients with EGPA treated with mepolizumab at the recruiting centers in 2015–2020. Treatment response was evaluated from 3 months to 24 months after initiation of mepolizumab. Complete response to treatment was defined as no disease activity (Birmingham Vasculitis Activity Score [BVAS] = 0) and a prednisolone or prednisone dose (or equivalent) of ≤4 mg/day. Respiratory outcomes included asthma and ear, nose, and throat (ENT) exacerbations. Results: Two hundred three patients, of whom 191 received a stable dose of mepolizumab (158 received 100 mg every 4 weeks and 33 received 300 mg every 4 weeks) were included. Twenty‐five patients (12.3%) had a complete response to treatment at 3 months. Complete response rates increased to 30.4% and 35.7% at 12 months and 24 months, respectively, and rates were comparable between mepolizumab 100 mg every 4 weeks and 300 mg every 4 weeks. Mepolizumab led to a significant reduction in BVAS score, prednisone dose, and eosinophil counts from 3 months to 24 months, with no significant differences observed between 100 mg every 4 weeks and 300 mg every 4 weeks. Eighty‐two patients (40.4%) experienced asthma exacerbations (57 of 158 [36%] who received 100 mg every 4 weeks; 17 of 33 [52%] who received 300 mg every 4 weeks), and 31 patients (15.3%) experienced ENT exacerbations. Forty‐four patients (21.7%) experienced adverse events (AEs), most of which were nonserious AEs (38 of 44). Conclusion: Mepolizumab at both 100 mg every 4 weeks and 300 mg every 4 weeks is effective for the treatment of EGPA. The 2 doses should be compared in the setting of a controlled trial. [ABSTRACT FROM AUTHOR]

Thus, even if it does not seem to be mandatory sending to an allergy workup all these patients, it can still be useful to make an allergy evaluation as even a low % detection rate can help patients' management (since test specificity if often close to 100%) in order to give indication about avoiding drugs in the future. Keywords: children; erythema multiforme; hypersensitivity drug reaction; lymphocyte transformation test; Mycoplasmapneumoniae; Mycoplasma-induced rash and mucositis; paediatrics; Stevens-Johnson syndrome EN children erythema multiforme hypersensitivity drug reaction lymphocyte transformation test Mycoplasmapneumoniae Mycoplasma-induced rash and mucositis paediatrics Stevens-Johnson syndrome 740 744 5 05/08/21 20210501 NES 210501 To the Editor, I Mycoplasma pneumoniae i (MP) infection is a common cause of community-acquired pneumonia in children sometimes associated with intriguing mucocutaneous manifestations variable in severity such as erythema multiforme (EM) or Stevens-Johnson syndrome (SJS).1 Various papers attempted to distinguish the clinical features of MP-associated diseases, but the topic is still confusing, ending in conflicting classifications.2-6 A systematic review suggested that they should be considered as distinct entities from the genuine drug-induced SJS, introducing the term ' I Mycoplasma i -induced rash and mucositis' (MIRM).7 Other authors used the expression ' I Mycoplasma pneumoniae i -associated mucositis' (MPAM) to distinguish a variant with isolated mucosal involvement without rash.8 Recently, MIRM have been included in a larger group called RIME (reactive infectious mucocutaneous eruption).9 Erythema multiforme is a cutaneous rash characterized by typical target lesions. Children, erythema multiforme, hypersensitivity drug reaction, lymphocyte transformation test, Mycoplasmapneumoniae, Mycoplasma-induced rash and mucositis, paediatrics, Stevens-Johnson syndrome. [Extracted from the article]