Diagnosis of drug causality in non-immediate drug hypersensitivity in children

Graham, François; Caubet, Jean-Christoph Roger J-P

doi:10.1080/17512433.2018.1494570

Cited by 3 publications

(1 citation statement)

References 46 publications

(86 reference statements)

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“…This may lead doctors and parents to empirical use of an alternative drug, which could place an extra financial burden on the health insurance system and/or the family, increase antibiotic resistance and ultimately result in ineffective treatment 8 . After a full allergy work‐up, however, less than 10% of these children will be confirmed to have a drug allergy 9 . In a study of 88 children, who were taking BL and presented a non‐immediate exanthema, the majority tested positive for a viral infection, mainly enterovirus and herpes viruses, while they had a negative response to an oral drug provocation test (DPT), and thus, no drug allergy was confirmed 10 .…”

Section: Introductionmentioning

confidence: 99%

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Tsabouri

Atanasković-Marković

2021

Pediatric Allergy Immunology

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Childhood rashes or exanthemas are common and are usually relatively benign. There are many causes of rash in children, including mainly viruses, and less often bacterial toxins, drugs, allergens and other diseases. Viral exanthema often appears while children are taking a medication in the course of a viral infection; it can mimic drug exanthema and is perceived as a drug allergy in 10% of cases. In the vast majority of cases, the distinction between virus‐induced and drug‐induced skin eruption during the acute phase is not possible. The drugs most commonly implicated are beta‐lactams (BL) and non‐steroidal anti‐inflammatory drugs (NSAIDs). Viruses, commonly Epstein‐Barr virus (EBV), human herpesvirus 6 (HHV6) and cytomegalovirus (CMV), and the bacterium, Mycoplasma pneumoniae, may cause exanthema either from the infection itself (active or latent) or because of interaction with drugs that are taken simultaneously. Determination of the exact diagnosis requires a careful clinical history and thorough physical examination. Haematological and biochemical investigations and histology are not always helpful in differentiating between the two types of exanthema. Serological and polymerase chain reaction (PCR) assays can be helpful, although a concomitant acute infection does not exclude drug hypersensitivity. A drug provocation test (DPT) is although considered the gold standard for the diagnosis and is not preferred by the patients. Skin tests are not well tolerated, and in vitro tests, such as the basophil activation test and lymphocyte transformation, are of low sensitivity and specificity and their relevance is debatable. Based on current evidence, we propose a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous eruption while receiving a drug.

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Section: Introductionmentioning

confidence: 99%

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Tsabouri

Atanasković-Marković

2021

Pediatric Allergy Immunology

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The negative predictive value of 5-day drug provocation test in nonimmediate beta-lactam allergy in children

Celik

Güvenir

Hurmuzlu

et al. 2020

Annals of Allergy, Asthma & Immunology

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Negative Predictive Value of Single-Day Drug Provocation Test for Immediate and Non-Immediate Beta-Lactam Hypersensitivity Reactions in Children

Genis,

Kuzucu,

Sengül Emeksiz

et al. 2024

Int Arch Allergy Immunol

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Introduction: Beta-lactam antibiotics (BLAs) commonly cause hypersensitivity reactions in children. These reactions are categorized into immediate reactions, which include urticaria, angioedema, bronchospasm, and anaphylaxis, and non-immediate reactions, such as maculopapular rashes and delayed-onset urticaria/angioedema. Rashes in children, often caused by infections, may be misdiagnosed as BLA allergy. However, over 90% tolerate the medication following an allergic evaluation. Methods: We aimed to evaluate patients with negative single-day drug provocation test (sdDPT) results for subsequent reactions and to determine the negative predictive value (NPV) of sdDPT for immediate (less than 1 h) and non-immediate (more than 1 h) suspected BLA allergy. In addition, non-immediate reactions were assessed by classifying them as occurring within 1–6 h or after 6 h. Patients who underwent sdDPT for suspected BLA allergy and tested negative between 2019 and 2023 were included in the study. They were questioned via telephone interviews about their reuse of the tested drug. Results: 404 patients who underwent sdDPT for suspected BLA allergy were evaluated. The NPV of BLA sdDPT was determined to be 97.3%. When patients were categorized based on the time interval between the last dose and the reaction, the NPV was 97% for those experiencing a reaction within the first hour of drug use and 96.7% for reactions occurring after more than 1 h. Non-immediate reactions were further evaluated, revealing an NPV of 98.7% for reactions occurring between 1 and 6 h, and 92.5% for reactions occurring after 6 h. Conclusion: Our findings demonstrate that sdDPT has a high NPV for both immediate and non-immediate reactions. However, the NPV of sdDPT was lower for reactions occurring more than 6 h after the last dose.

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Diagnosis of drug causality in non-immediate drug hypersensitivity in children

Cited by 3 publications

References 46 publications

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

The negative predictive value of 5-day drug provocation test in nonimmediate beta-lactam allergy in children

Negative Predictive Value of Single-Day Drug Provocation Test for Immediate and Non-Immediate Beta-Lactam Hypersensitivity Reactions in Children

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