Diagnosing Single and Multiple Drug Hypersensitivity in Children: A Tertiary Care Center Retrospective Study

Abstract

Drug hypersensitivity reactions (DHRs) are a type of adverse drug reactions with heterogeneous pathophysiological mechanisms and a broad spectrum of clinical manifestations. Since over-diagnosing is common in children, a complete allergy work-up is needed. A cross-sectional study was conducted at a tertiary care institution, covering the five-year period. Five hundred and four patients of both sexes, mean age 7.5 and with a medical history suggestive of DHR were evaluated. ENDA/EAACI guidelines were used for a diagnostic algorithm. Single drug hypersensitivity was registered in 375 patients and multiple drug hypersensitivity in 129. The main culprits in medical history were antibiotics (83%), non-steroidal anti-inflammatory drugs (NSAIDs) (8.4%) and analgoantipyretics (3.8%). Skin involvement was registered in 96.2%. DHRs were confirmed in 4.4% patients—six patients had positive skin tests and 13 had a positive drug provocation test. In the proven DHRs group, the main agents were antibiotics (72.7%), followed by NSAIDs (8.3%), and of all the skin manifestations, urticaria was most common (78.2%), followed by exanthema (10.5%) and angioedema (5.3%). Considering the above, anticipating DHRs and a proper referral of children to an allergologist is a key step in the assessment of drug hypersensitivity. A complete allergy work-up prevents unnecessary drug exclusion and allows most children to safely continue the use of first-line medications when needed.

Characteristics of Drug Hypersensitivity Reactions in Children: A Retrospective Analysis in an Allergy Outpatient Clinic

“…Milosevic et al (16) reported that DHRs could be confirmed in 4.4% of patients presenting with suspicion of DHRs. Similarly, in our study, drug allergy could be confirmed in 4.9% of the reactions with drug allergy tests.…”

“…The low frequency of confirmed DHRs in studies conducted in patients presenting with suspected DHRs emphasizes the importance of diagnostic drug tests (15,16). Because many untested children with suspected DHRs may be incorrectly identified with drug allergy labels, which may lead to the unnecessary use of broad-spectrum, less-effective, and/or more expensive medications.…”

Practical Approach to Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Children

“…Most often, basophils and mast cells are stimulated to release inflammatory mediators by IgE mediation, but other mechanisms are also known, such as non-IgE and non-immune activation of mast cells. According to Milosecic K. et al, the most common manifestation of drug hypersensitivity in children was acute urticaria (78.2%), followed by exanthema (10.5%) and angioedema (5.3%) [ 19 ].…”

Recent findings on drug hypersensitivity in children

“…Another study investigating DHR in children was conducted in Serbia ( 10 ). They evaluated 504 patients, with a mean age of 7.5 years.…”

“…Urticaria was the most common skin manifestation (78.2%), followed by exanthema (10.5%) and angioedema (5.3%). The presence of extracutaneous manifestations was significantly associated with a positive allergy test ( p = 0.022, OR 4.62, 95% CI 1.05–15.76%) ( 10 ).…”