Evaluation of drug provocation tests in Korean children: a single center experience

Background: Acetaminophen is the most commonly used antipyretic in children. However, there are limited data assessing hypersensitivity reactions related to acetaminophen usage. Objectives: To conduct a systematic review to characterize reported reactions to acetaminophen in adults and children, and perform a meta-analysis to assess the prevalence of acetaminophen hypersensitivity in children with a suspected acetaminophen allergy. Methods: We performed a systematic review of studies reporting hypersensitivity reactions to acetaminophen by searching 2 electronic databases. From the selected studies, we included those assessing the prevalence of acetaminophen hypersensitivity by performing oral challenge in our meta-analysis. Results: Eighty-five studies were included in the systematic review, assessing a total of 1,030 participants. Immediate (within 1 h of exposure) hypersensitivity reactions were reported in > 25% of the articles, while cutaneous nonimmediate reactions were similarly reported in about 25% of the articles. The remaining articles reported Steven-Johnson syndrome/toxic epidermal necrolysis, fixed drug eruptions, and cross-intolerance reactions. Five pediatric studies were included in our meta-analysis. The prevalence of acetaminophen hypersensitivity reaction among children undergoing oral challenge was 10.1% (95% confidence interval 4.5–15.5). Conclusion: Future studies assessing the risk of immediate and nonimmediate hypersensitivity reactions to acetaminophen and elucidating the mechanism of acetaminophen hypersensitivity reactions are required.

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“…1). The 85 remaining articles [3, 9, 13-21, 24-97] were included in the qualitative analysis (online suppl. Table S1; for all online suppl.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis

Gabrielli¹,

Langlois²,

Ben‐Shoshan³

2018

Int Arch Allergy Immunol

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“…У деяких дослідженнях показано, що реакція на НПЗП може бути більш бурхливою, ніж реакція на β-лактамні антибіотики, особливо при тяжких реакціях [51][52][53]. У Кореї НПЗП були другим найбільш поширеним причинним агентом у пацієнтів, яким проводилося шкірне алерготестування, після β-лактамів [54]. Як показано на рис.…”

Section: нестероїдні протизапальні препаратиunclassified

Медикаментозная Аллергия У Детей: Что Нужно Знать?

Nyankovskyy¹,

Nyankovska²,

Yatsula³

et al. 2021

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Drug reactions cause 6.5 % of all hospital admissions. They develop with a rate of 15 % in patients who are treated in hospitals. The risk of drug reactions should be considered in the differential diagnosis when any medical problem occurs in a person who uses medication. In children, the major difficulty in the diagnosis of drug allergy is differentiation of maculopapular drug eruptions from viral exanthem which is observed very commonly in this age group. In treatment of allergic reactions, the first step is to immediately discontinue the drug. Avoidance of using over-the-counter medicines and using drugs orally if possible are important in terms of prevention of drug allergies. Cross-reactivity between drugs with similar structure should be considered when choosing an alternative medication. Antihistamines, in particular dimetindene maleate — Edermik, can be used for the prevention and treatment of drug reactions at the outpatient stage.

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Are you sure that it is a drug allergy?

Chung

2020

Clin Exp Pediatr

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Adverse drug reactions (ADRs) include 2 types, namely types A and B. Type A ADRs include overdose toxicity, commonly observed side effects, indirect effects, and drug-drug interactions based on a drug's inherent pharmacological action. Type B ADRs include intolerance, drug idiosyncrasy, drug hypersensitivity reactions (DHRs) caused by immunological mechanisms and pseudoallergic reactions caused by nonimmune mechanisms. 1) A DHR is a drug-mediated immunological mechanism in sensitized patients and occurs in a narrow sense in combination with drug allergies (DAs). 2) The clinical manifestation of DA is variable; sometimes children already have various diseases when suspected allergic symptoms occur. In children, respiratory and gastrointestinal symptoms, along with skin symptoms, are the most common allergic symptoms, which are like those of the underlying disease for which the drug is administered. Therefore, clinicians may miss some DAs. Moreover, clinicians diagnose DAs according to drug administration history alone without performing a diagnostic evaluation. Drug provocation tests (DPTs) and skin tests were previously performed for suspected DAs in 43 children who were assessed by physicians to have DHRs. Among them, however, DHRs were confirmed only in 3 patients. 3) The DPTs were positive in about 25%-30% of children with suspected DHR. 4,5) These results differed from those suspected clinically and those confirmed by diagnostic evaluation. The diagnosis of DA based on medical history alone is vague and unreliable, leading to overdiagnosis. Limiting the prescriptions of drugs causing suspected DAs without a definite diagnosis restricts the number of alternative drugs, especially in children who have fewer approved options than adults. It is important to accurately diagnose a DA because difficulty selecting appropriate drugs can result in less effective treatment and the need for subsequent treatment, which in turn can increase medical costs. This review of drug allergies in children 6) highlights a wide range of topics, including DA epidemiology, the causative agent, and diagnostic methods. When diagnosing DA, history taking and examination are important to determining suspected diseases and drugs. Furthermore, objective tests such as skin tests, DPTs, and serum tests are performed. To accurately diagnose

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Evaluation of drug provocation tests in Korean children: a single center experience

Abstract: DPTs can be performed safely in children with suspected ADRs in order to achieve a correct diagnosis.

Cited by 6 publications

References 23 publications

Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis

Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis

Медикаментозная Аллергия У Детей: Что Нужно Знать?

Are you sure that it is a drug allergy?

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