Antibiotic Allergy in Children: More than Just a Label

Abrams, Elissa M.; Netchiporouk, Elena; Miedzybrodzki, Barbara; Ben‐Shoshan, Moshe

doi:10.1159/000501518

Cited by 25 publications

(27 citation statements)

References 91 publications

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“…On the other hand, unpredictable reactions occur in vulnerable children, unrelated to pharmacological activities actions, and are not a dose dependent. Unpredictable reactions may also be further subdivided into drug intolerance, drug idiosyncrasy, drug allergy, and pseudo-allergic reactions (13,14). Historically, the impression has been given that children are at a lower risk of ADRs than adults (15).…”

Section: Adverse Drug Reactionsmentioning

confidence: 99%

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Antibiotic Usage in the Pediatric Population: The Need for Effective Role of Parents and Prescribers

Karataş¹,

Khan²

2021

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ÖzAntibiyotikler pediatrik tıbbi tedavinin önemli bir yönüdür ve enfeksiyon hastalıkları çocuk ölümlerinin önde gelen nedenidir. Antibiyotikler, bakteriyel enfeksiyonların tedavisinin temel taşıdır ve çocuklar bu ilaçları diğer ilaç sınıflarından daha sık almıştır. Antibiyotiklerin uygunsuz kullanımı uluslararası bir endişe kaynağıdır ve uygun ve güvenli antibiyotik kullanımının teşviki saatin ihtiyacıdır. Hastanelerdeki ve toplumdaki yetersiz antibiyotik reçetelerinin yüksek yüzdesi, dünya genelindeki pediatrik popülasyonda bildirilmektedir. Çocuklarda uygunsuz ve aşırı antibiyotik kullanımı direnç ve advers ilaç reaksiyonlarına (ADR'ler) yol açar. Ebeveynler ve reçete yazanlar, çocuklarda antibiyotik reçetesini etkiler. Hem ebeveynler hem de reçete yazanlar için doğru araçlarla, yalnızca doğru kişiler tarafından uygun eğitim müdahalesinin, uygun olmayan antibiyotik uygulamaları sorununu yeterince iyileştirebileceği ve antimikrobiyal direnç riskini kademeli olarak ortadan kaldırabileceği bildirilmektedir. Bu anlatı gözden geçirme belgesi, çocuklarda antibiyotiklerin kullanımı, ADR'ler, alerji, hatalar ve endikasyon dışı kullanımına genel bir bakış sağlamakta ve antibiyotik tedavisinin kullanımında ebeveynlerin ve reçete yazanın önemli rolünü tartışmaktadır.

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Section: Adverse Drug Reactionsmentioning

confidence: 99%

“…Data on the prevalence and incidence of antibiotic hypersensitivity reactions are limited, particularly in pediatric age and vary globally. Antibiotic allergy constitutes roughly 5-10 percent of all adverse drug reactions (13,19). It was noted that ADRs constitute a "major public health issue" in children.…”

Section: Antibiotic Allergymentioning

confidence: 99%

Antibiotic Usage in the Pediatric Population: The Need for Effective Role of Parents and Prescribers

Karataş¹,

Khan²

2021

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“…8 Avoiding mislabelling of patients with antibiotic allergy will ensure that patients are managed with the most appropriate, safe, and cost-effective antibiotic. 9,10 Until recently, it was considered unethical to challenge children with suspected antibiotic allergy in the absence of skin testing. However, two recent studies, 11,12 including one performed in Canada, 11 cast doubt on the utility of this guideline as they suggest that challenges, but not skin testing, are essential to the appropriate diagnosis of antibiotic allergy.…”

Section: Introductionmentioning

confidence: 99%

“…13 Understandably, correctly diagnosing antibiotic allergy is important as it mitigates the potential for adverse health outcomes and financial costs. 9 Despite these factors, antibiotic challenges are not routinely performed and families are often inappropriately burdened by a misdiagnosis. Moreover, the impact of being delabelled subsequent to a passed challenge remains unknown.…”

Section: Introductionmentioning

confidence: 99%

GRAded oral challenge for Drug allergy Evaluation—Delabelling described through families' voices

Protudjer

Golding

Bouwman³

et al. 2020

Clin Experimental Allergy

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Background Children are often diagnosed with an antibiotic allergy, with little investigation to confirm whether it is a true allergy. Recent studies support the use of oral challenges to confirm antibiotic allergy. Yet, little is known about families' perceptions of these challenges, or experiences of living with a misdiagnosis, often for many years. Objective To describe how families with a child previously labelled as “antibiotic allergic,” but who has subsequently been delabelled, perceive the experience of misdiagnosis and subsequent delabelling. Methods We performed semi‐structured interviews with parents whose children had recently completed a graded oral challenge for antibiotic allergy. Interview transcripts were analysed concurrently, but independently, by two investigators, using content analysis. Results A total of 15 parents (14 individual interviews; 1 mother‐father dyad) participated. Children were, on average, 5.04 ± 4.5 years and were first diagnosed in infancy (mean age: 1.82 ± 1.48 years) subsequent to a rash (14/14; 100%), and commonly at a walk‐in clinic (6/14; 42.9%). We identified four themes: (1) A red, raised rash results in a quick diagnosis despite a lack of testing, (2) sensitive care allays concerns, (3) delabelling brings relief, but also mystery and calls for proper diagnoses, and (4) quick diagnoses are reckless, but manageable through downward comparisons. Conclusion and Clinical Relevance These findings underscore the importance of a careful physical examination and clinical history of the patient, but also an ongoing dialogue to support families, both of which would ideally begin at the time of initial investigation.

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“…Oral challenge tests are considered to be the gold standard to establish or exclude drug hypersensitivity[72]. According to a low frequency of hypersensitivity it is recommended that a graded challenge is performed in the context of a low likelihood of drug allergy[72,73]. Several studies about cross reactivity in this drug group have suggested that the overall risk is low given the differences in size of the lactone ring[74].…”

mentioning

confidence: 99%

Spanish Society of Allergology and Clinical Immunology (SEAIC) Vision of Drug Provocation Tests

Audicana

Ortega

Lobera

et al. 2021

J Investig Allergol Clin Immunol

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The controlled drug exposure test (DPT) is currently considered the gold standard for the diagnosis of drug allergy. Drug-induced adverse reactions (ADRs) are a growing reason for consultation in both primary and specialized care. Allergology consultations in Spain are the ones that usually study these ADRs and rule out immunological mechanisms involved in up to 90% of the cases consulted. An adequate approach to these cases has an obvious impact on the costs and efficacy of the treatments required by other specialists, so that if we did not use DPTs, patients would require more expensive, more toxic and less effective treatments in most of the cases. In recent years, a large number of new drugs have been developed and this document is intended to be a practical guide in the management of PDT with the vision of the Spanish Allergology Society. Diagnostic work begins with a detailed history of the patient. Skin tests are only useful for some medications, and in most cases the diagnosis can only be confirmed by DPT. Although there is usually cross-reactivity, DPTs can confirm the diagnosis and also help to find a tolerable alternative drug. The individual management of patients in a programmed way, taking into account both the type of drug to be studied and the patient's comorbidities, usually allows a solution to be found for the majority of patients.

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Antibiotic Allergy in Children: More than Just a Label

Cited by 25 publications

References 91 publications

Antibiotic Usage in the Pediatric Population: The Need for Effective Role of Parents and Prescribers

Antibiotic Usage in the Pediatric Population: The Need for Effective Role of Parents and Prescribers

GRAded oral challenge for Drug allergy Evaluation—Delabelling described through families' voices

Spanish Society of Allergology and Clinical Immunology (SEAIC) Vision of Drug Provocation Tests

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