Usefulness of drug provocation tests in children with a history of adverse drug reaction

Abstract

PurposeThere are very few reports of adverse drug reactions (ADR) and almost no study of drug provocation test (DPT) in Korean children. We aimed to assess the role of DPT in children with unpredictable ADRs, and compare the causative drugs and clinical characteristics between detailed history of ADRs and result of DPTs.MethodsWe included 16 children who were experienced ADRs referred to pediatric allergy clinic at Ajou University Hospital (January 2006 to December 2009). With various suspected drugs, 71 DPTs were done in 16 patients using our own protocol, and skin tests to antibiotics were combined in ADRs to antibiotics in medical history.ResultsThere were 17 (23.9%) positive DPTs results out of 71 individual DPTs, and 11 patients (68.8%) from 16 patients were positive to at least one drug. Drugs causing positive reactions were acetaminophen in 5 (31%), Non-steroidal anti-inflammatory drugs in 4 (25%), penicillin in 3 (19%), cephalosporin in 2 (13%), and cotrimoxazole, macrolide and lactose in 1 each.ConclusionDPT seems a safe and useful procedure to confirm causative drug and identify safely administering alternative drugs in children with ADR.

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

“…23,24 A previous Korean study also reported a lower positive rate of 23.9% (17/71 cases) compared to that of our study. 15 We postulated that the number of patients included in this study and the background factors of study subjects were the cause of differences in the prevalence of positive DPT findings.…”

“…8 However, there is a scarcity of data with respect to DPTs in Korean children. 7,15 Thus, we analyzed all of the DPTs performed in our pediatric allergy clinic over the course of 20 years. Importantly, this is the largest and most extensive pediatric DPT study conducted in Korea to date.…”

“…[22][23][24] A previous Korean study also reported that the most common drugs associated with ADRs are acetaminophen, NSAIDs, penicillin, and cephalosporins. 15 as high molecular weight and the ability to act as a hapten. 2 Such ADRs may also be due to the fact that these are the most commonly prescribed drugs during childhood.…”

“…14 Although ADRs are more commonly associated with a negative effect on medical treatment and are associated with more significant morbidity in children compared to adults, there are relatively few studies on the results of pediatric DPTs. 5,15,16 In particular, ADRs not only affect patient quality of life, but can also lead to delayed treatment and even mortality as a result of the smaller number of medicines that are generally available to children. 2,16 On the other hand, excessive concerns about ADRs may compel the use of less effective and more expensive alternative treatments owing to restrictions on appropriate drug use.…”

Drug Allergy in Children: What Should We Know?

“…2,3033) According to domestic reports, drug provo cation tests (DPT) could be safely performed in pediatric pa tients with higher diagnostic accuracy. 34,35) Crossreactivity between betalactam antibiotics is due to the side chain R1 in amoxicillin, ampicillin, and cefaclor, which have identical or almost identical side chains, have been shown to have crossreacti vity by skin test ing; and in ceftriaxone and cefotaxime, which have identical side chains and also show skin test crossreacti vity. It is recommended that we evaluate medication side chains to safely challenge beta lactams with different side chains.…”