Hypersensitivity Drug Reactions (HDR) In Latin America. Similarities and Differences Between Children and Adults

Abstract

RATIONALE: HDR are frequent motives for consultation in Allergology services. Possible etiologic factors and clinical presentation differences between Latin American children and adults have not been described yet. METHODS: An observational cross sectional study using a modified ENDA questionnaire was implemented in 19 allergology units in 11 Latin-American countries, reporting patients presenting HDR in the last year before consultation. Causal relationship was categorized according to WHO-UMC Causality Categories: certain, probable, possible, unlikely and conditional. RESULTS: 727 patients, 144 (19.8%) of them under 18 years old, presented 732 reactions. Female gender was 71.7% in adults, and 50% in children. Atopic history was present in 44.9 and 63.8% and a history of previous drug reaction in 31.9 and 36.9% of adults and children, respectively. Fourteen percent of adult, and 10.7% of children had presented previous reactions with the same drug. The clinical picture of the reaction in adults and children was angioedema in 47.9 and 48.6%, urticaria in 44.5 and 41.8%, maculopapular and macular exanthema in 20.3 and 22.6 %, erythema multiforme and SJS in 3.6 and 2.7% respectively. Certain and probable causal relationships were attributed in adults and children to NSAIDs in 55.7 and 60.3 %, beta lactams in 11.2 and 19.8%, non beta lactam antibiotics in 8.4 and 2.5 %, anticonvulsants in 3.2 and 1.7%, chemotherapy 0.8 and 2.5% of patients, respectively. CONCLUSIONS: Female sex was predominant in adults but not in children. NSAIDs and antibiotics were the drugs implicated in more than 75% of patients. Beta lactam antibiotics were more frequently involved in children.

Multiple Nonsteroidal Anti-Inflammatory Drug-Induced Cutaneous Disease: Relevance, Natural Evolution and Relationship with Atopy

“…In the work by Doña et al [4], which includes the largest series of subjects suffering from HRs to drugs studied to date, the most frequently confirmed diagnosis was hypersensitivity to multiple NSAIDs (47.29%), followed by immediate reactions to beta-lactam (18.12%) and quinolone (6.8%) antibiotics. A recent multicenter study presented at the last meeting of the American Academy of Allergy, Asthma and Immunology including more than 700 cases from 11 countries showed that NSAIDs accounted for 55 and 60% of reactions in adults and children respectively, whereas beta-lactams were responsible for less than 20% of the reactions in both groups [5]. Moreover, recent works by Zambonino et al [6,7 ]showed that only 8% of patients with symptoms suggestive of beta-lactam hypersensitivy could be confirmed as such compared to 68% for NSAID-hypersensitive patients.…”