Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests

Arıkoğlu, Tuğba; Aslan, Gulen; Batmaz, Sehra Birgül; Eskandari, Gülçin; Helvacı, İlter; Kuyucu, Semanur

doi:10.1007/s11096-015-0100-9

Cited by 33 publications

(31 citation statements)

References 41 publications

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“…Drug desensitization is described as a temporary induction of drug tolerance by the administration of incremental doses of the drug. 47 It is important to realize that drug desensitization is a therapeutic measure for the safe administration * Refs 25,26,28,31,[35][36][37]43,154,155. of a drug to a patient who has either a proven or is highly likely to have a drug allergy as opposed to drug challenge, which is a diagnostic procedure performed in cases of low probability of drug allergy. 23,47 In addition, drug challenge and desensitization should be done in a monitored setting and are contraindicated in patients with severe non-IgE-mediated reactions, such as SJS, TEN, DRESS syndrome, interstitial nephritis, hepatitis, or hemolytic anemia.…”

Section: Drug Desensitizationmentioning

confidence: 99%

Antibiotic Allergy in Pediatrics

et al. 2018

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The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.

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Section: Drug Desensitizationmentioning

confidence: 99%

Antibiotic Allergy in Pediatrics

et al. 2018

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“…In addition, it has been shown that most of the children with reported hypersensitivity could tolerate macrolides, and macrolide hypersensitivity was confirmed in only 6.2-15.5% of the reported cases [17,18]. In another study in children in our country, the frequency of confirmed macrolide hypersensitivity was 27.2% (3/11) [19]. In this study, the number of patients is lower than in ours, and all confirmed cases had immediate reactions.…”

Section: Discussionmentioning

confidence: 96%

Proven Non-β-Lactam Antibiotic Allergy in Children

Güvenir

Mısırlıoğlu

Çapanoğlu

et al. 2016

Int Arch Allergy Immunol

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Background: Parallel to the increasing use of non-β-lactam (NBL) antibiotics, allergic reactions to this drug group seem to increase. Data about NBL antibiotic hypersensitivity in children are limited. The aim of this study is to evaluate characteristic reactions to NBL antibiotics in children. Method: Patients with suspected NBL allergy were assessed between 2011 and 2015. Characteristics of the reactions and results of skin and drug provocation tests (DPTs) were recorded. Results: In total, 96 patients aged 75.15 ± 56.77 months (range: 3-208) were assessed. Clarithromycin (63.6%) was the most common cause of reactions reported. After ingestion of NBL antibiotics, maculopapular rash, urticaria/angioedema and anaphylaxis presented in 48.9, 40.7 and 10.4% of the patients, respectively. Tests were performed in 85 patients. Intradermal tests were positive in 3 patients (clarithromycin, ciprofloxacin and cotrimoxazole) and DPT was positive in 1 patient (clarithromycin). Eleven patients could not be tested. Seven patients had severe anaphylaxis, and 4 patients with urticaria/angioedema had to take their medications at the time of the reaction so desensitization was performed. When only patients confirmed by tests were evaluated, NBL allergy was 4.7% (4/85) in our study group. However, when patients who could not be tested, but were regarded as suffering from drug hypersensitivity according to clinical findings, were included, the frequency of NBL allergy was 15.6% (15/96). Conclusion: Most of the children with suspected NBL do not have true hypersensitivity. The frequency of confirmed hypersensitivity is low, and thus a detailed history should be taken from patients with suspected NBL hypersensitivity and DPTs should be performed in patients without contraindications.

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“…Arıkoğlu ve ark. (17) da çocuklardan oluşan çalışma grubunda en sık amoksisilin klavulonik asite karşı reaksiyon bildirmiştir. Aynı çalışmada makrolidler ise en sık non-beta laktam alerji gelişen antibiyotik grubunu oluşturmaktadır).…”

Section: Discussionunclassified

“…Arıkoğlu ve ark. (17), çocuk yaş grubunda ilaç alerjilerinin tanısını %55.1'inde DPT, %44.8'nde İPT yoluyla doğrulamıştır. Çalışmamızda 9'u şüpheli ilaçla olmak üzere 27 DPT uygulandığında şüpheli ilaçlarla yapılanların 4'ünde (%44.4) pozitiflik saptandı.…”

Section: Discussionunclassified