Management of Multiple Drug Allergies in Children

Dioun, Anahita F.

doi:10.1007/s11882-011-0239-y

Cited by 16 publications

(12 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A minority are dose independent, including antibody-and IgE-mediated reactions. 52,53,55,56 The off-target mechanism of non-IgE-mediated mast cell activation for many drugs (such as opiates, neuromuscular blocking agents, fluoroquinolones, and potentially vancomycin) entails the dose-dependent activation of a specific mas-related G proteincoupled receptor on mast cells. 57,58 Red man syndrome because of non-IgE-mediated mast cell activation secondary to vancomycin administration is a clinical example of a type B reaction in children.…”

Section: Classification Of Adrsmentioning

confidence: 99%

“…The provider should determine if treatment was required for the reaction as well as the response to treatment. 32,55,102,103 If a provider is suspicious that an IgE-mediated allergic reaction occurred (Table 1), workup should be considered (Fig 6). Immediate reactions that typically occur within 1 hour of exposure to oral drugs or within 15 to 20 minutes for parenteral drugs should prompt referral to an allergist for further workup.…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Antibiotic Allergy in Pediatrics

et al. 2018

View full text Add to dashboard Cite

The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.

show abstract

Section: Classification Of Adrsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Antibiotic Allergy in Pediatrics

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Considering that cutaneous adverse drug reactions in our patients were associated with delayed hypersensitivity, the protocol should be referred to as the 'induction of tolerance' rather than 'desensitization.' However, at present 'desensitization' is used when referring to various non-IgE-mediated hypersensitivity reactions, because the pathomechanism of desensitization is not fully understood and nonimmunologic mechanisms are thought to be involved 927. In addition, numerous studies have found successful desensitization to non-IgE-mediated reactions, such as those involving sulfonamide, temozolomide, and allopurinol, and in doing so reflect the extended meaning of desensitization 282930.…”

Section: Discussionmentioning

confidence: 99%

Desensitization to Oxcarbazepine: Long-Term Efficacy and Tolerability

et al. 2017

View full text Add to dashboard Cite

Background and PurposeAntiepileptic drug (AED)-associated cutaneous adverse drug reactions can lead to the discontinuation of medications. The aim of this study was to determine the long-term efficacy and safety of performing desensitization to oxcarbazepine.MethodsThis study involved 20 patients who exhibited cutaneous adverse drug reactions associated with oxcarbazepine use between July 2009 and March 2016 at Samsung Medical Center. All of the participants had to discontinue oxcarbazepine despite presenting initially positive responses. Human leukocyte antigen genotyping was performed to detect the genetic predisposition to Stevens-Johnson syndrome. The desensitization to oxcarbazepine was performed with a starting dosage of 0.1 mg/day. Efficacy was evaluated by comparing the frequency of seizures before and at 1 and 3 years after desensitization. Adverse events occurring during desensitization and the retention rate after desensitization were also investigated.ResultsNineteen patients (95%) safely completed the desensitization protocol. One withdrew owing to emotional problems that appeared to be associated with oxcarbazepine. The follow-up period was 4.6±1.2 years (mean±SD), and oxcarbazepine was maintained for more than 3 years after desensitization in 15 patients (83.3%). The response rates were 84.2% and 77.8% at 1 and 3 years after desensitization, respectively. Eight patients remained seizure-free for 3 years, and two discontinued all AEDs. Transient adverse reactions such as mild rash and itching were reported by five patients during desensitization.ConclusionsThis study has demonstrated the long-term efficacy and safety of desensitization to oxcarbazepine in patients exhibiting cutaneous adverse drug reactions. This favorable outcome should encourage the implementation of desensitization in patients presenting with hypersensitivity to oxcarbazepine as an alternative strategy in clinical practice.

show abstract

“…This is particularly true in the setting of latent tuberculosis where treatment options are limited. Desensitization induces a temporary state of tolerance to a medication that has provoked a hypersensitivity response by administering incremental doses of the medication until the total cumulative therapeutic dose is achieved (2). This tolerance can be maintained as long as the medication is administered at regular intervals without discontinuation or missed doses (3).…”

mentioning

confidence: 99%

“…As patients with CGD are at increased risk for invasive bacterial and fungal infections, conservative therapy is based on the lifelong prophylactic use of cotrimoxazole and itraconazole. The latter substantially lowers the incidence of invasive aspergillosis and thus significantly improved long-term outcome in CGD in terms of morbidity and mortality (2). However, multiple drug interactions of itraconazole must be considered as itraconazole raises levels of calcineurin inhibitors (tacrolimus, cyclosporine A), while rifampicin lowers levels of itraconazole (3).…”

mentioning

confidence: 99%