Drug allergy claims in children: from self‐reporting to confirmed diagnosis

Gomes, Eva; Fonseca, João; Araújo, Luís; Demoly, Pascal

doi:10.1111/j.1365-2222.2007.02870.x

Cited by 147 publications

(51 citation statements)

References 41 publications

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“…Previous Portuguese population studies on the prevalence of drug HS found that 8% of adults and 6% of children self-reported allergy to at least one drug, with NSAIDs being the second-most suspected [14,15]. In a recent Portuguese study on drug-induced anaphylaxis, NSAIDs were the most frequent culprits [16].…”

Section: Introductionmentioning

confidence: 99%

Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs among Adults: Clinical Features and Risk Factors for Diagnosis Confirmation

Gomes

Geraldes²,

Gáspár³

et al. 2016

Int Arch Allergy Immunol

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Background: Nonsteroidal anti-inflammatory drugs (NSAIDS) are among the most common causes of drug hypersensitivity (HS) reactions. The diagnosis is based on a careful clinical history, and provocation tests are considered the gold standard for diagnosis. Skin tests have some value to study reactions to pyrazolones. Laboratory investigations are mostly used for research purposes. Different phenotypes have been described. Objective and Methods: Our aim was to describe the most common clinical manifestations of NSAID HS in a large population of adult patients, the drugs involved, the association with previously described risk factors, and the outcome of diagnostic procedures. The classification of reactions proposed by the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group was adopted. Results: Acetylsalicylic acid was the drug most often involved in reactions (34%), isolated cutaneous symptoms were the most reported (60%), and immediate reactions (58%) were the most common. There was an overall female predominance (64%) and 35% of the patients were atopic. HS to NSAIDs was confirmed in 21% of the patients. The most common phenotypes encountered among HS patients were NSAID-induced urticaria/angioedema and single-NSAID-induced urticaria/angioedema or anaphylaxis. Logistic regression analysis showed that gender and atopy were not significant risk factors for HS confirmation, but diagnosis depended on the number of previous reactions, the type of reaction, and the time interval between drug intake and reaction. Conclusion: Only 21% of suspected HS reactions were confirmed after diagnostic workup. Patients describing >1 previous reaction and suffering immediate reactions had a higher probability of a positive investigation.

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Section: Introductionmentioning

confidence: 99%

Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs among Adults: Clinical Features and Risk Factors for Diagnosis Confirmation

Gomes

Geraldes²,

Gáspár³

et al. 2016

Int Arch Allergy Immunol

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“…The evidence review found that the prevalence of true penicillin allergy is much less common than perceived allergy and that re-sensitisation to β-lactam drugs was infrequent 4–6. A detailed history is required for an accurate diagnosis of a drug-induced reaction and skin prick tests should not be used to screen for drug allergy in the absence of a clinical history compatible with IgE-mediated drug allergy 7.…”

Section: Resultsmentioning

confidence: 99%

The RCPCH care pathway for children with drug allergies: an evidence and consensus based national approach

Toit

Lloyd

Sinnott³

et al. 2011

Archives of Disease in Childhood

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This pathway demonstrates the spectrum of drug allergy is varied and may differ for young children compared with older children and adults. The authors highlight the paucity of evidence to support allergy testing for most drugs, in children, other than supervised incremental provocation tests (when indicated). Acute presentations require emergency health professionals to address underlying allergic issues, including recognition and avoidance of potential drug allergy triggers. Non-acute presentations may include multi-system symptoms which may have a broad differential diagnosis; this document signposts to the relevant partners in the RCPCH care pathway portfolio. Management combines a care package including a definitive diagnosis, initiating treatments and ongoing education.

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“…Although approximately 8% of Americans are labelled as being allergic to penicillin [7], a meta-analysis by Harandian et al [8] found that just 3% of patients with penicillin allergy in their medical records had a confirmed diagnosis of immediate reactions by skin or drug provocation tests. The difference appears to be even more striking in the paediatric population, in whom penicillin allergy diagnoses based solely on clinical history are more common [1, 9, 10]. According to the above-mentioned meta-analysis, the frequency of confirmed immediate reactions to penicillin is less than 2% in children [8].…”

Section: Introductionmentioning

confidence: 99%

“…According to the above-mentioned meta-analysis, the frequency of confirmed immediate reactions to penicillin is less than 2% in children [8]. Overdiagnosis of penicillin allergy has also been reported for non-immediate reactions, as children with infectious rashes are frequently misdiagnosed with allergic maculopapular exanthemas [1, 9]. …”

Section: Introductionmentioning

confidence: 99%

Hospitalizations in Children with a Penicillin Allergy Label: An Assessment of Healthcare Impact

Sousa‐Pinto

Araújo

Delgado

2018

Int Arch Allergy Immunol

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Background: Beta-lactam allergy is overdiagnosed. Diagnosis of penicillin allergy has been associated with a greater use of hospital resources and an increased risk of antibiotic-resistant infections, although this issue remains poorly studied in children. We aimed to compare patient characteristics and use of hospital resources in hospitalized children with and without a record of penicillin allergy. Methods: We identified all hospitalizations in children labelled as being allergic to penicillin in a database containing all hospitalizations in Portuguese public hospitals between 2000 and 2014, and compared these with a similar number of age-, sex-, and main diagnosis-matched hospitalizations without a penicillin allergy label. Comparisons were made for length of hospital stay, comorbidities (Charlson Comorbidity Index), in-hospital mortality, and hospitalization costs. Results: We identified 1,718 hospitalizations corresponding to children labelled as penicillin-allergic. Compared with patients without such a label, these children had longer hospital stays (mean 5 vs. 4 days, p = 0.03) and a higher comorbidity index (mean 0.11 vs. 0.09, p < 0.001). Hospitalization costs were also higher (EUR 2,071 vs. 1,798), but the difference was not significant (p = 0.12). Conclusions: Hospitalizations of children labelled as allergic to penicillin are associated with longer hospital stays, more comorbidities, and a tendency towards higher hospitalization costs. An accurate diagnosis of penicillin allergy based on clinical history and confirmatory tests is therefore essential in all paediatric patients.

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Drug allergy claims in children: from self‐reporting to confirmed diagnosis

Abstract: ADRs are frequently reported in children, and many children are classified as having a DAll. After complete evaluation, only a few of these reactions can be attributed to DHs and DAll. Most of the patients (94% in this study) could actually tolerate the initially suspected drug.

Cited by 147 publications

References 41 publications

Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs among Adults: Clinical Features and Risk Factors for Diagnosis Confirmation

Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs among Adults: Clinical Features and Risk Factors for Diagnosis Confirmation

The RCPCH care pathway for children with drug allergies: an evidence and consensus based national approach

Hospitalizations in Children with a Penicillin Allergy Label: An Assessment of Healthcare Impact

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