Disparities in rate, triggers, and management in pediatric and adult cases of suspected drug‐induced anaphylaxis in Canada

Gabrielli, Sofianne; Clarke, Ann E.; Eisman, Harley; Morris, Judy; Joseph, Lawrence; Vieille, Sébastien La; Small, Peter; Lim, Rodrick; Enarson, Paul; Zelcer, Michal; Chan, Edmond S.; Mill, Chris; Ben‐Shoshan, Moshe

doi:10.1002/iid3.201

Cited by 26 publications

(24 citation statements)

References 39 publications

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“…NSAIDs anaphylaxis is at the second rank as triggers of pediatric drug‐induced anaphylaxis. Of note, NSAID hypersensitivity ranks at the first place in few epidemiologic studies …”

Section: Culprit Drugsmentioning

confidence: 99%

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Atanasković-Marković

Gomes

Cernadas³

et al. 2019

Pediatric Allergy Immunology

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Drug hypersensitivity reactions (DHR) constitute a major and common public health problem, particularly in children. One of the most severe manifestations of DHR is anaphylaxis, which might be associated with a life‐threatening risk. During those past decades, anaphylaxis has received particularly a lot of attention and international consensus guidelines have been recently published. Whilst drug‐induced anaphylaxis is more commonly reported in adulthood, less is known about the role of drugs in pediatric anaphylaxis. Betalactam antibiotics and non‐steroidal anti‐inflammatory drugs are the most commonly involved drugs, probably related to high prescription rates. Diagnosis relies on the recognition of symptoms pattern and is based on complete allergic workup, particularly including skin tests and/or specific IgE. However, the real diagnostic value of those tests to diagnose immediate reactions in children remains not well defined for a significant number of the drugs. Generally, a drug provocation test is discussed to confirm or exclude an immediate‐onset drug‐induced hypersensitivity. Although avoidance of the incriminated drug (and related drug) is the rule, rapid desensitization is useful in selected subgroups of patients. There is a need for large, multicentric studies, to evaluate the real diagnostic value of the currently available skin tests. Moreover there is also a need to develop new diagnostic tests in the future to improve the management of these children.

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“…NSAIDs anaphylaxis is at the second rank as triggers of pediatric drug‐induced anaphylaxis. Of note, NSAID hypersensitivity ranks at the first place in few epidemiologic studies …”

Section: Culprit Drugsmentioning

confidence: 99%

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Atanasković-Marković

Gomes

Cernadas³

et al. 2019

Pediatric Allergy Immunology

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“…Regarding SCARs, the drugs involved depend on the population (adults or children). In this sense, antibiotics and anticonvulsants are the most common ones in adults ; and antibiotics, NSAIDs, and chemotherapeutics as well as aromatic anticonvulsants and also allopurinol are the most frequently involved in children . Over the last years, DHRs to new drugs as monoclonal antibodies, sulphasalazine and antituberculosis drugs have also been reported .…”

Section: The Burden Of Drug Hypersensitivitymentioning

confidence: 99%

“…This indicates the need to accurately evaluate these patients to reduce unnecessary inpatient/outpatient use of second‐line treatments that may otherwise produce greater use of hospital resources . In children with suspicion of DHRs to different drugs, from which NSAIDs and BLs were the most frequent, less than 10%‐20% of cases were confirmed as allergic . This mislabelling could be due to the fact that some symptoms (gastrointestinal or headache) are falsely considered as allergic, the virus and antibiotic interaction or the underlying infection itself can lead to cutaneous reactions, the low sensitivity of skin testing (STs) and the natural history with spontaneous resolution over time .…”

Section: Mislabelling Influences Dhr Real Incidencementioning

confidence: 99%

“…In this sense, antibiotics and anticonvulsants are the most common ones in adults 10 ; and antibiotics, NSAIDs, and chemotherapeutics 11 as well as aromatic anticonvulsants and also allopurinol are the most frequently involved in children. [12][13][14] Over the last years, DHRs to new drugs as monoclonal antibodies, sulphasalazine and antituberculosis drugs have also been reported. [15][16][17] The drug implication is not always associated with consumption rates, since in some highly worldwideprescribed drugs, as proton-pump inhibitors (PPIs), the risk of severe DHRs is low.…”

Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

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Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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“…Parenteral administration, particularly via the intravenous route, has already been defined as a risk factor for drug-induced anaphylaxis [11, 42]. Another study analyzing cephalosporin-related adverse reactions retrospectively found that physician-documented anaphylaxis ratios due to oral or parenteral administration of cephalosporins were similar; our study once more points out the importance of the route of drug administration for the development of anaphylaxis, independent of the type of causative drug [43].…”

Section: Discussionmentioning

confidence: 74%

Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients

Demir¹,

Erdenen²,

Gelincik

et al. 2018

Int Arch Allergy Immunol

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Aim: To investigate the potential risk factors in patients who have experienced anaphylaxis from drugs. Method: The study included 281 adult patients (median age 40 years; 76.5% female) who experienced immediate types of hypersensitivity reaction to a drug. The patients were divided into an anaphylaxis group and a nonanaphylaxis group. The anaphylaxis group was diagnosed according to the criteria of the World Allergy Organization. Skin testing with culprit drugs was performed. In the nonanaphylaxis group, drug provocation tests were performed with culprit drugs, including aspirin or diclofenac, to determine nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. Atopy was determined by skin prick tests with the common inhalant allergens. Patients’ demographics, clinical features, and baseline tryptase and total IgE levels were compared between the 2 groups. Results: The median interval between the last reaction in the patient’s history and the study evaluation was 7 months (range 1–120 months). In 52.3% of the patients, reactions were defined as anaphylaxis. The most common culprit drugs were NSAIDs (56.9%) and β-lactams (34.7%). The culprit drugs were used parenterally in 13.2% of the patients. 34.9% of the patients had comorbid diseases and 24.6% used additional drugs, the most common being antihypertensives (10%). Atopy was determined in 28.8% and 28.1% of the patients were smokers. The median serum level of baseline tryptase and total IgE was 3.5 µg/L and 77 kU/L, respectively. In 46.3% of the patients, skin tests with culprit drugs were positive and the positivity ratio was higher in the anaphylaxis group (p = 0.002). Anapyhlaxis was more common in patients who were: hypertensive, atopic, using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and received the culprit drug parenterally (p = 0.034, p = 0.04, p = 0.03, p = 0.035, p = 0.013, and p < 0.001). In the multivariate analysis, it was observed that the parenteral usage of the drug and the presence of atopy were significantly higher in the anaphylaxis group (p < 0.001, odds ratio [OR] = 20.05, confidence interval [CI] 4.75–88.64; p = 0.012, OR = 2.1, CI 1.17–3.74). Age, smoking, family history, and serum levels of baseline tryptase and total IgE did not differ between groups. Conclusion: The parenteral route and atopy increase the risk of drug-induced anaphylaxis. IgE-mediated sensitivity to the culprit drug seems to facilitate anaphylaxis.

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Disparities in rate, triggers, and management in pediatric and adult cases of suspected drug‐induced anaphylaxis in Canada

Cited by 26 publications

References 39 publications

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

Recent developments and highlights in drug hypersensitivity

Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients

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