Recognising Antibacterial Hypersensitivity In Children

Romano, Antonino

doi:10.2165/00148581-200002020-00003

Cited by 17 publications

(13 citation statements)

References 113 publications

(170 reference statements)

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“…This fact supports the idea that most of the suspected reactions to this class of antibiotics are not a true allergic phenomenon and are probably related with the infectious process. 3,4 Our results are slightly lower than the results of Pichichero 23 and differ from those found by other authors. 10,24 We should note that the frequency of positive tests to betalactams found in the present study is similar to the results reached in adult studies.…”

Section: Discussioncontrasting

confidence: 98%

“…22 In children, true nonimmediate allergic drug reactions associated with skin eruptions seem lower than in adults and are commonly attributed to infections. 4 The diagnostic work up for drug allergy is complex and time consuming. A diagnostic protocol which includes skin testing to betalactams is considered useful in clarifying the nature of the reaction.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 In children, the prevalence of allergic adverse reactions to betalactam seems to be significantly lower than in adults, as in paediatric age infectious diseases are responsible for the clinical picture. 3,4 In clinical practice, patients who have experienced a drug reaction are frequently categorised as being allergic to the culprit drug without any further investigation. This leads to frequent over-diagnosis of drug allergy.…”

Section: Introductionmentioning

confidence: 99%

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Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Chambel

Martins

Silva

et al. 2010

Allergologia et Immunopathologia

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Background: Few studies have been performed in children with suspected betalactam allergy. We aimed to assess the role of the drug provocation test (DPT) with betalactams in a paediatric setting and to study the association between allergy to betalactam antibiotics and other allergic diseases. Methods: We included all the patients under 15 years old who were consecutively referred to the Immunoallergy Department, Dona Estefânia Hospital, Portugal (January 2002 to April 2008) for a compatible history of allergic reaction to betalactam. All were submitted to a DPT. Children were proposed to perform skin tests (ST) to betalactam antibiotics followed by DPT. If they decline ST, a DPT with the culprit drug was performed. Results: We studied 161 children, 60% were boys, with a median age of 5 years old at the time of the DPT. Thirty-three patients (20.5%) had an immediate reaction and 33 (20.5%) a non-immediate reaction. The severity of the reported reactions was low in most cases. Skin tests to betalactams were performed in 47 children and were positive in 8. DPT was positive in only one (3.4%) of the patients skin tested and in 11 (13.4%) of those not skin tested. The severity of the DPT reaction was low. Asthma and food allergy were associated with a positive DPT in the later group. Conclusions: DPT seems a safe procedure even in the absence of ST in non-severe cases. This could be a practical option in infants and pre-school children, where ST are painful and difficult to perform. Additional caution should be taken in children with asthma and food allergy.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Chambel

Martins

Silva

et al. 2010

Allergologia et Immunopathologia

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“…In fact, in children such manifestations are thought to be mainly caused by the infection itself (69). In any case, a diagnostic protocol which includes delayed-reading intradermal tests and patch tests can be helpful in clarifying the nature of many of these reactions.…”

Section: Diagnostic Evaluation Of Childrenmentioning

confidence: 99%

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Romano

Blanca

Torres

et al. 2004

Allergy

324

368

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Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during β‐lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug‐specific T‐cell clones obtained from the circulating blood and the skin, suggest that a type‐IV (cell‐mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work‐up, the patient's history is fundamental; patch testing is useful, together with delayed‐reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug.Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to β‐lactams.

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“…Although the most common reason for cutaneous eruptions in children is viral infection, drugs used during the infection may complicate differential dignosis, because many infectious agents can cause maculopapular rash and urticaria which are the most commonly seen signs of drug allergy in children (1)(2)(3). In addition, early evaluation of cutaneous eruptions is very important for pediatricians in drug reactions which may have a severe course (4).…”

Section: Introductionmentioning

confidence: 99%

Çocuklarda ilaç ilişkili döküntüler; tek merkez deneyimi

Özmen¹,

Şahin²,

Yöney³

et al. 2011

tpa

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C Cu ut ta an ne eo ou us s d dr ru ug g e er ru up pt ti io on ns s i in n c ch hi il ld dr re en n; ; a a s si in ng gl le e c ce en nt tr re e e ex xp pe er ri ie en nc ce e S Se er ra ap p Ö Öz zm me en n, , M Mu ur ra at t fi fia ah hi in n* *, , A Ay ys se el l Y Yö ön ne ey y* *, , N Ni il lü üf fe er r A Ar rd da a* *, , Z Za af fe er r A Ar rs sl la an n O Or ri ig gi in na al l A Ar rt ti ic cl le e S Su um mm ma ar ry y Aim: Cutaneous drug reactions are commonly reported adverse drug reactions. The aim of this study was to describe the clinical pattern of drug eruptions, determine drugs commonly associated with those patterns seen among children and to suggest an approach to this problem. One hundred children were enrolled in the study, There were 75 boys and 25 girls with an age range of 6 months to 14 years old (mean 5.6±3.6 years). Statistical analyses were done using SPSS 11.5 package program (SPSS Inc., Chiago, IL). For general information related to variants descriptive statistics and frequency distributions were calculated. While continuously measured variables were shown as mean± SD, categorical variables were expressed as frequency (percentage). The study was approved by the hospital's ethic committee. Material andResults:The most common indication for using drug therapy was upper respiratory tract infection (64%). The most commonly suspected drugs were amoxicillin/ampicillin in 44% and cephalosporins in 27% of the patients. The types of drug eruption included urticaria (64%), maculopapular eruption (28%), urticaria-purpura (5%), erythema multiforme (1%), fixed drug eruption (1%) and drug hypersensitivity syndrome (1%). While 60% of the patients were diagnosed with probable drug allergy and %16 were diagnosed with possible drug allergy, drug allergy was confirmed only in 18% of the patients who were diagnosed with definite drug allergy. Conclusions:A detailed drug history, a knowledge of the varied patterns of drug eruptions and appropiate diagnostic tests are essential factors for successful management of a child with drug eruption (Turk Arch Ped 2011; 46: 62-6)

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Recognising Antibacterial Hypersensitivity In Children

Cited by 17 publications

References 113 publications

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

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