Diagnosing multiple drug hypersensitivity in children

Atanasković-Marković, Marina; Gaeta, Francesco; Gavrović-Jankulović, Marija; Veličković, Tanja Ćirković; Valluzzi, Rocco Luigi; Romano, Antonino

doi:10.1111/pai.12020

Cited by 29 publications

(57 citation statements)

References 34 publications

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“…[4,8] Similar to our observations, others also noted multiple drug allergy to be rare in children; but Atanaskovic et al in their study on drug reaction in pediatric population documented that 2.5% of those with suspected drug allergy were allegic to multiple drugs. [9] The reaction patterns observed were comparable to existing data on multiple drug allergy. [1] Unlike described in literature, most of the patients with multiple drug allergy syndrome in our study (90%) showed similar pattern of reaction irrespective of the culprit drug.…”

Section: Discussionsupporting

confidence: 73%

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A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

Sukumarakurup¹,

Riyaz²,

Sasidharanpillai³

et al. 2015

jemds

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BACKGROUNDThough multiple drug allergy syndrome or multiple drug hypersensitivity syndrome has been described as a distinct entity, not much data is available on the same, especially in Indian literature. AIMSTo study the incidence of multiple drug allergy syndrome among patients with cutaneous adverse drug reaction (CADR) attending a referral centre and to study its clinical and epidemiological features and evidence of autoimmunity. METHODSAll patients admitted in Dermatology ward of our tertiary care hospital for a 2-year period from 1 st August 2012 to 31 st July 2014 with CADR were studied for documented evidence of CADR to two or more unrelated drugs. The subjects were included in this prospective study after clearance from institutional ethics committee and written informed consent from study subjects. The cases identified as multiple drug allergy syndrome were studied in a more detailed manner and were evaluated for comorbidities with special reference to autoimmune diseases and human immunodeficiency virus infection. The clinical patterns and the common offending drugs were studied. RESULTSDuring the two-year study period, 10 out of the 94 patients with CADR included in the study were found to be belonging to the category of multiple drug allergy syndrome (After strict scrutiny) with a clear female predilection (70%). The different reaction patterns in patients with multiple drug allergy syndrome were fixed drug eruption, urticaria, erythema multiforme, angioedema, drug reaction with eosinophilia and systemic symptoms (DRESS) and exfoliative dermatitis. Six out of ten patients with multiple drug allergy syndrome showed positivity on antinuclear antibody profile and two were diagnosed to have systemic lupus erythematosus. CONCLUSIONSA 10.6% of those admitted with CADR have multiple drug allergy syndrome, which exists as a separate entity. Female predominance and the evidence of autoimmune manifestations in the majority underscores the need to evaluate the role of autoimmunity in precipitating allergy to multiple drugs. Large prospective studies with age and sex matched controls in different population groups may throw light on the less known aspects of this syndrome. A decision to investigate all patients with allergy to multiple drugs for evidence of autoimmunity may be worthwhile.

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Section: Discussionsupporting

confidence: 73%

“…[2] Unlike our study, some other studies found antiepileptics to be one of the offenders. [9,10] Nine out of ten patients with multiple drug allergy syndrome in our study group showed allergic reaction to one or more NSAIDs and in six of them the first episode of drug allergy was precipitated by a NSAID.…”

Section: Discussionmentioning

confidence: 99%

A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

Sukumarakurup¹,

Riyaz²,

Sasidharanpillai³

et al. 2015

jemds

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“…Patch tests have been suggested to be especially useful to diagnose nonimmediate hypersensitivity to anticonvulsants and NSAIDs, but further large studies are needed to evaluate their diagnostic value .…”

Section: Diagnostic Approach To Drug Hypersensitivity In Childrenmentioning

confidence: 99%

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

Gomes

Brockow

Kuyucu

et al. 2015

Allergy

251

336

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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.

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“…Some allergological studies, mostly in adults, rarely including children, reported on results of skin tests and provocation tests (17,21,55,57,77,78). A problem in diagnosing macrolide hypersensitivity is that some macrolides are not available in injectable form and hence IDTs are not possible.…”

Section: Macrolidesmentioning

confidence: 99%

“…Sensitivity and specificity for this concentration in IDT have been reported as 75% and 90%, respectively. In a limited number of studies that included few children, all or most of children with suspected macrolide hypersensitivity tolerated oral provocation, and up to only 12% of the reactions were confirmed (17,21,55,60,77,78).…”

Section: Macrolidesmentioning

confidence: 99%

Hypersensitivity reactions to non‐betalactam antibiotics in children: An extensive review

Kuyucu

Mori

Atanasković-Marković

et al. 2014

Pediatric Allergy Immunology

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In contrast to hypersensitivity reactions (HSRs) to β-lactam antibiotics in children, studies about HSR to non-β-lactam antibiotics (NBLAs) such as sulfonamides, macrolides, quinolones, and antituberculosis agents are scarce, and information is generally limited to case reports. The aim of this extensive review was to summarize our present knowledge on clinical characteristics, evaluation, and management of HSR to NBLAs in children based on the literature published between 1980 and 2013. NBLAs have been reported to induce a wide spectrum of HSRs from mild eruptions to severe, and sometimes fatal, systemic drug reactions, especially in some high-risk groups. The diagnosis relied upon history and remained unconfirmed by allergological tests in most of the cases. Obtaining a detailed history is valuable in the diagnosis of suspected reactions to NBLAs. Diagnostic in vivo and in vitro tests for NBLAs lack validation, which makes the diagnosis challenging. The definitive diagnosis of NBLA hypersensitivity frequently depends upon drug provocation tests. Studies including children showed that only 7.8 to 36% of suspected immediate and delayed HSRs to NBLAs could be confirmed by skin and/or provocation tests. Therefore, a standardized diagnostic approach and management strategy should be developed and employed for pediatric patients in the evaluation of suspected HSRs to NBLAs, some of which may be critical and unreplaceable in certain clinical situations.

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Diagnosing multiple drug hypersensitivity in children

Cited by 29 publications

References 34 publications

A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

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

Hypersensitivity reactions to non‐betalactam antibiotics in children: An extensive review

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