Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

Abstract

When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sicknesslike reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

“…The rash may be due to the drug, the infection, or the combination. Recent publications have emphasized the safety and effectiveness of oral provocation in children after the resolution of the illness, as the majority of children will tolerate rechallenge without reaction or with only a mild skin reaction (reviewed in Gomes et al 2016 (98)). Diagnostic drug provocation must be distinguished from therapeutic desensitization, or tolerance induction, which is the technique used to induce a state of unresponsiveness to the substance that continues as long as the drug is given (99).…”

Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

“…Because of the relative lack of studies, the pediatric guidelines for the management of drug hypersensitivity in children have been based on “expert” opinions held within long‐standing practice, resulting in far too many inaccurate and painful intradermal tests among children. But new guidelines are now incorporating recent evidence and OPT without skin tests are recommended for mild non‐immediate suspected reactions . The determination of the real diagnostic value of skin tests would definitely improve the management of children with suspicion of BLH and possibly decrease medical costs.…”

“…Thus, a significant number of children develop different types of skin rashes while being treated with an antibiotic. The vast majority of these children, concerning about 5% of general pediatric population according to studies based on questionnaire, are considered as allergic, mainly due to fear of a more severe reaction, without appropriate allergy testing. After a proper evaluation, allergy will be confirmed only in a small proportion of these children .…”

Fifteen-minute consultation: A child with a suspected drug allergy

“…Beta-lactam antibiotics are the most common cause of drug allergy in the paediatric population,5 followed by NSAIDs and non-beta-lactam antibiotics 6…”