Parental‐reported drug allergy in 6‐ to 9‐yr‐old urban schoolchildren

SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

show abstract

“…The prevalence of self-reported reactions to betalactams in children varies from 1.7% to 5.2% [226][227][228].…”

Section: Epidemiologymentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

View full text Add to dashboard Cite

show abstract

“…Este achado está de acordo com o reportado por outros autores. 8,[17][18][19] Num estudo efetuado na Turquia, 20 numa amostra de 2 855 crianças dos seis aos nove anos, foi encontrada uma prevalência reportada de 2,8%. O estudo de Rebelo Gomes et al 8 numa amostra de 1 426 crianças com uma idade média de 7,3 ± 4,3 anos, recrutadas em consultas externas de diversas especialidades da cidade do Porto, encontrou uma prevalência reportada de alergia a medicamentos de 6,0%.…”

Section: Discussionunclassified

Alergia a Medicamentos Reportada em Crianças que Frequentam Infantários

et al. 2014

View full text Add to dashboard Cite

Introduction: Data about drug allergy prevalence in the general population, particularly in children, are lacking. This study aimed to estimate the prevalence of parent-reported drug allergy, in children attending day care centers in Lisbon and Oporto. Material and Methods: In Phase II of the "ENVIRH study -Environment and Health in Children Day Care Centers", a health questionnaire which included questions about drug allergies was administered to children by stratified, random sampling of day care centers. Results:The final analysis included 1,169 questionnaires, 52.5% from boys. The mean age was 3.5 ± 1.5 years. The prevalence of reported drug allergy was 4.1% (95% CI: 3.0 -5.2%). The most frequently reported drugs were antibiotics (27 cases) and NSAIDs (in 6 cases). In the multivariate analysis, reported drug allergy was directly associated with age (OR 1.19; 95% CI 1.01 -1.41) and reported food allergy (OR 3.19; 95% CI 1.41 -7.19). It was inversely associated with the level of parental education (OR 0.25; 95% CI 0.10 -0.59). Discussion: Even though the limitations of the study our results are in accordance with those reported by previous authors and suggest that there is a high prevalence of reported drug allergy in the considered age group. Conclusion: A correct assessment of these situations is needed in order to avoid unnecessary drug evictions. Keywords: Child Day Care Centers; Child; Drug Hypersensitivity; Prevalence; Portugal. INTRODUÇÃOAs reações adversas a medicamentos (RAM) constituem um grave problema de saúde pública, estimando-se que afetem 7% da população geral e 20% dos doentes hospitalizados.1 Têm também sido apontadas como causas de morte relevantes quer em adultos, quer em crianças. 2A Organização Mundial de Saúde define RAM como qualquer resposta prejudicial, não intencional e indesejá-vel, a um fármaco administrado em doses normalmente usadas em seres humanos para a profilaxia, diagnóstico ou terapia. 3,4As RAM podem ser classificadas em vários subtipos. 5As RAM de tipo B (cerca de 15%), 3 que atingem somente indivíduos suscetíveis e são independentes da dose, incluem as reações de hipersensibilidade.As reações de hipersensibilidade alérgicas definem-se como reações adversas com um mecanismo imunológico subjacente, que surgem na sequência da administração de um medicamento.6 Estima-se que até 1/3 das RAM em doentes hospitalizados possa ser de etiologia alérgica.

show abstract

“…In a prospective study including children, rashes occurred in 8.5% of the patients prescribed cotrimoxazole [14]. In two studies including different age groups of children, the frequency of hypersensitivity reactions caused by sulfonamides was found to be 1.6 and 9.9% based on history [4,5]. In our study, cotrimoxazole was the second most commonly suspected agent (14/96, 14.6%), and confirmed hypersensitivity was found to be 14.2% (2/14).…”

Section: Discussionmentioning

confidence: 99%

“…In population-based questionnaire surveys among children in different countries, parent-reported drug hypersensitivity ranged from 2.8 to 5.4%, of which 10-20% were associated with NBL antibiotics, but only 7.8-36% of suspected reactions could be confirmed by skin and/or provocation tests [3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

Proven Non-β-Lactam Antibiotic Allergy in Children

Güvenir

Mısırlıoğlu

Çapanoğlu

et al. 2016

Int Arch Allergy Immunol

View full text Add to dashboard Cite

Background: Parallel to the increasing use of non-β-lactam (NBL) antibiotics, allergic reactions to this drug group seem to increase. Data about NBL antibiotic hypersensitivity in children are limited. The aim of this study is to evaluate characteristic reactions to NBL antibiotics in children. Method: Patients with suspected NBL allergy were assessed between 2011 and 2015. Characteristics of the reactions and results of skin and drug provocation tests (DPTs) were recorded. Results: In total, 96 patients aged 75.15 ± 56.77 months (range: 3-208) were assessed. Clarithromycin (63.6%) was the most common cause of reactions reported. After ingestion of NBL antibiotics, maculopapular rash, urticaria/angioedema and anaphylaxis presented in 48.9, 40.7 and 10.4% of the patients, respectively. Tests were performed in 85 patients. Intradermal tests were positive in 3 patients (clarithromycin, ciprofloxacin and cotrimoxazole) and DPT was positive in 1 patient (clarithromycin). Eleven patients could not be tested. Seven patients had severe anaphylaxis, and 4 patients with urticaria/angioedema had to take their medications at the time of the reaction so desensitization was performed. When only patients confirmed by tests were evaluated, NBL allergy was 4.7% (4/85) in our study group. However, when patients who could not be tested, but were regarded as suffering from drug hypersensitivity according to clinical findings, were included, the frequency of NBL allergy was 15.6% (15/96). Conclusion: Most of the children with suspected NBL do not have true hypersensitivity. The frequency of confirmed hypersensitivity is low, and thus a detailed history should be taken from patients with suspected NBL hypersensitivity and DPTs should be performed in patients without contraindications.

show abstract

Parental‐reported drug allergy in 6‐ to 9‐yr‐old urban schoolchildren

Cited by 45 publications

References 21 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Alergia a Medicamentos Reportada em Crianças que Frequentam Infantários

Proven Non-β-Lactam Antibiotic Allergy in Children

Contact Info

Product

Resources

About